Photo & Video Release | Uncommon Ground Initiative

Section 1

Individual Information

Full Name *

Date of Birth

Is this person 18 or older?

Section 2

Parent / Guardian (if participant is under 18)

Parent / Guardian Name *

Relationship

Phone

Section 3

Select Your Release Option *

UGI will never sell your images or use them in a way that is inconsistent with our mission. All participants are portrayed with dignity and respect.

Full Release

Option A

I grant UGI the right to photograph, film, and use my image (or my minor child's) without compensation, for any and all purposes related to UGI's mission. This grant is non-exclusive, royalty-free, and may be used in perpetuity.

Limited Release

Option B

I give permission for my image to be used only for the specific platforms I select below.

Social media (Instagram, TikTok, Facebook, YouTube) UGI website Fundraising and donor communications Print flyers and event programs

No Release

Option C

I do not give permission for my image or likeness to be used by UGI in any form. I understand UGI staff will be notified and will make reasonable efforts to exclude me from photography.

Section 4

Additional Restrictions

Any specific preferences or restrictions we should know about? (Optional)

Section 5

Signature

Sign with your finger or mouse below. If signing on behalf of a minor, this is the parent or guardian's signature.

Sign here

🎉

All done.

Both forms are now on file. Your teen is cleared for their first UGI event. We can't wait to meet them.

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Photo & Video Release Form