Jay Nolan PR Consent Form.pdf

I, , being of legal age to consent or the legal parent(s), guardian(s), or conservator(s) of the above named individual who is a minor child or person unable to consent on his or her own behalf, give Jay Nolan Community Services, Inc. (JNCS) the right to use the above named individual's name and any photograph, video, voice recording, or any other likeness in any media form, now known and hereafter created, for the purpose of promoting JNCS' mission, products, services, or programs. JNCS also has the right to substitute the above named individual's voice if deemed proper by JNCS. I agree that such items belong to JNCS and remain free and clear of any claim on my part or the part of the above named individual. I understand that I may terminate authorization at any time for future photographs, video, voice recordings, or other likenesses produced of the above named individual by delivering written notice to the Executive Director of JNCS. However, said termination shall not cover items previously authorized and already in production/use.