Online Fundraising Livestream Consent Form
Please complete this form to provide your consent for participation and media release in the fundraising livestream event.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Organization or Affiliation (if applicable)
Media Release Consent: I grant permission for the use of my image, voice, and likeness in livestream recordings, promotional materials, and related content.
*
I agree to the media release terms above.
Date of Consent
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
*
Submit Consent
Submit Consent
Should be Empty: