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Photo Release for Person Under 18 Years of Age

I hereby grant the right to The Arc of Pennsylvania and to its employees, affiliates, and consultants to create, copy, reproduce, exhibit, publish, or distribute any likeness of my dependent to be used for the purposed of promoting The Arc of Pennsylvania’s Arc Discovery Employment and Transitions program. I understand that the above uses may include, but are not limited to video recordings, films, sound recordings, photographs, displays, brochures, websites, multi-media programs, or any other type of promotional medium existing now or in the future. I further understand that by granting this permission I am irrevocably giving up all rights and claims to monetary compensation for any future uses of this material by the above persons & organizations.
Child's Information
I certify that I am a custodial parent or guardian and have the aforementioned rights to assign.
First Name
Last Name
Country
Address Line 1
City
State
Postal Code

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