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Media Release Form

Thank you for your interest in FDDC's upcoming media campaign.

Please complete the media consent form below

Photos and materials submitted may be used for various FDDC campaigns and use. This includes but is not limited to social media, the website, in print or for materials such as stickers, postcards, buttons, etc.

By signing this media consent release form you are granting the FDDC the ability to take, alter, edit, copy, exhibit, publish, distribute and make use of any and all pictures or video taken of you to be used for the lawful purpose of marketing materials. 

"*" indicates required fields

Photo/Video/Quote/Story Authorization for Use

I hereby authorize the Florida Developmental Disabilities Council, Inc. (FDDC), its funding agency, and funded representatives/projects to take, edit, alter, copy, exhibit, publish, distribute, and make use of any and all photographs, videos, quotes, and/or stories about me. I understand the above may be shared in a variety of media, languages, and formats for the purposes of public outreach, awareness, and education pertaining to FDDC-funded activities conducted and accomplishments achieved. This authorization shall continue indefinitely unless I otherwise revoke said authorization in writing. 
By selecting the "I Consent" box, I agree to the terms of this media consent ageement electronically.*
(Signature of person in photo/video/providing quote/providing story)
Name*

Parent and/or legal guardian Authorization for Use

If the person above is under 18 years of age or does not have the legal right for providing consent, I certify that I am the parent and/or legal guardian, and I give my consent on his/her behalf.
(Signature of person in photo/video/providing quote/providing story)
Parent and/or Legal Guardian Name
This field is for validation purposes and should be left unchanged.
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