SAGA Empowerment Services Corp/photo/media consent form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Full Name *FirstLastEmail Address *Phone NumberDescription of Study / Procedure or Consent Full Consent Options *I have read and understood the information provided and I voluntarily agree to participate.I understand that I can withdraw my consent at any time without penalty.I consent to the collection and use of my data as described.I consent to be contacted for future related studies.Date of Consent *PhotoMedia Description (type of photos, video, audio, or media coverage)PhotoMedia Consent Options *I consent to be photographed or recorded (photo, video, audio) during this activity or event.I consent to the use of my image, voice, and likeness in printed and digital PhotoMedia materials (including websites and social media).I understand that PhotoMedia may be edited, copied, exhibited, published, or distributed for lawful purposes.I understand that I will not receive payment or royalty for the use of PhotoMedia in which I appear.I understand that I may withdraw PhotoMedia consent in writing for future use, where reasonably possible.Submit
