1900 Grant Street, Suite 400 | Denver, CO 80203-4304
303.327.4240 | Fax 303.327.4260 | Toll Free 866.864.5226
www.nursefamilypartnership.org
IMAGE RELEASE AND CONSENT AGREEMENT (“Release”)
Name: ______________________________________________________
By signing this Release, I agree to allow the Nurse-Family Partnership (“NFP”) to quote me or use photographs, video recordings or electronic images of me and/or my child in any of its publications, including NFP’s website, NFP’s social media platforms like Facebook, Instagram or Twitter, and in NFP’s marketing materials, like brochures, signs or ads. I understand that I will not receive any kind of payment when NFP uses my picture or quotes me in its materials. I understand and agree that NFP will own these materials. By signing this Release, I am authorizing NFP to edit, alter, copy, display, publish and distribute my image in order to advertise the NFP program or for other marketing purposes. I understand and agree that I will not have the right to inspect or approve of NFP’s finished products, even if they include my picture.
By signing this Release, I agree that I will not sue NFP or claim any expenses, damages, or losses for NFP’s use of my image.
I am 18 years old or older and I am able to contract in my own name. If I am under age 18, a parent or guardian has signed below. I have read this Release before signing it and I fully understand its meaning and impact on me.
By checking this box, I agree to allow NFP to contact me, even after I graduate from the program. I understand that I can ask NFP to stop contacting me at any time.
Text/Cell number: Email:
__________________________________
(Authorized Signature / Date)
__________________________________ ______________________________
(Printed Name) Child’s Name (if applicable)
If the person signing is under age 18, this Release must also be signed by a parent or guardian.
By signing below, I confirm that I am the parent or guardian of ______________________________ _, named above. I am giving my consent willingly to this release on behalf of this person.
______________________________________________ ________________________
(Parent/Guardian’s Signature) (Date)
_______________________________________________________________
(Parent/Guardian’s Printed Name)
_______________________________________________________
(Address)
________________________________________________________
(City, State, Zip Code)
Telephone number __________________________________________
Email _____________________________________________________
Agency _____________________________________________________