Consent & Authorization Form

Before you register, please agree to this disclosure.

MEDIA CONSENT FORM FOR ADULTS

  • I,
  • , participate in programs and activities with Kidney Donor Match Non-Profit Organization.

  • I hereby consent to participation in interviews, the use of quotes and the taking of photographs and/or videos of me on behalf of Kidney Donor Match Non-Profit Organization. and its staff. I also grant the right to edit, use, and reuse said products for non- profit, non-commercial purposes, including in print, online, social media and all other forms of media. I consent to the use of my name and association with Kidney Donor Match Non-Profit Organization. for the foregoing purposes:
  • Date Format: MM slash DD slash YYYY
 


 

MEDIA CONSENT FORM FOR MINORS

  • I hereby consent to the participation in interviews, the use of quotes, and the taking of photographs, movies or video tapes of the minor named above by. I also grant to the right to edit, use, and reuse said products for non- profit purposes including use in print, on the internet, and all other forms of media. I also hereby release the Kidney Donor Match Non-Profit Organization and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above. I consent to the use of my name and association with Kidney Donor Match Non-Profit Organization for the foregoing purposes:
    • News media (online, print and/or broadcast)
    • Publications and/or promotional materials
    • Closed circuit television programs
    • Advertisements
    • Websites and social media
    • Any other lawful purpose
    I give this authorization without expectations of compensation. This consent will remain in effect until I revoke it in writing.
  • Date Format: MM slash DD slash YYYY
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