Media and Photo Release

Name of Individual Being Served by Clark DD*

First Last

Parent or Guardian Name (If applicable)

First Last

Your Email

Your Phone*

I authorize Developmental Disabilities of Clark County (DDCC) to use the individual above's name, photo, video, comments or other media for the purpose of publicizing accomplishments and achievements in newsletters, brochures, websites, social media, and any other public relations activities for DDCC. This may include any activities in which s/he participates, including but not limited to Special Olympics, public or private employment, day services, and special events. I authorize DDCC to edit, copy, exhibit, publish and distribute this information without prior notification and without payment or any other consideration. I understand and agree that these materials are the property of DDCC. I waive the right to inspect or approve the finished product including written or electronic copy. Permission granted will allow the use of the media permanently unless otherwise slated or DDCC receives a written request to stop its use.*

YES
NO (story/photo cannot be used)

Type your full name below to sign as the person legally responsible for the individual named above. (Individual, Parent, or Guardian)*

OPTIONAL PHOTO UPLOAD (CHOOSE A FILE OR FILES TO UPLOAD)

Drop files here or

Accepted file types: jpg, gif, avi, mp4, mpeg, , Max. file size: 2 GB, Max. files: 4.

Phone

This field is for validation purposes and should be left unchanged.