Charity Drive Media Consent Form
Share your media and attribution preferences for the charity drive.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Relationship to the Charity Drive
Donor
Volunteer
Participant
Other
Media Types You Agree May Be Captured
Photo
Video
Audio
Written quote
Preferred Name Attribution
Full name
First name only
No name
Permission Scope
*
I permit charity-drive-related promotional and informational use of the media types and attribution selected on this form.
I do not grant permission for use.
Restrictions or Context You'd Like the Charity to Know
Consent Declaration: I give permission for the selected media to be captured and used in connection with the charity drive according to my selections on this form.
*
I agree to this declaration.
Signature
*
Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Consent
Submit Consent
Should be Empty: