Media Release Form

I, the undersigned, do hereby consent and agree that Freedom Service Dogs, Inc., its employees, volunteers, or agents have the right to use my story and take photographs, videotape, sound recordings, or digital recordings of me, my likeness, and performance and to use these in any and all media for the purpose of promoting the mission of Freedom Service Dogs. Use may include, but is not limited to, website, social media, newsletters, advertising, publicity, fundraising, training, print, and televised media. I further consent that my name and identity may be revealed therein or by descriptive text or commentary. I do hereby release to Freedom Service Dogs, Inc., its agents, and employees all rights to exhibit this work in print and electronic form publicly or privately. I waive any rights, claims, or interest I may have to copyright or control the use of my identity or likeness in whatever media used. Any right to inspect, approve, or disapprove any such pictures or recordings is hereby waived by the undersigned.

I understand that there will be no financial or other compensation for photographing or recording me.

I release Freedom Service Dogs, Inc. and its legal representatives from any legal responsibility related to the photograph or video in which I am included.

I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement.

I authorize Freedom Service Dogs, Inc. to use the following description of me and my service dog, in marketing materials such as, but not limited to, social media, newsletters, the Freedom Service Dog’s website, etc. I also authorize Freedom Service Dogs, Inc. to share the following description with donors, volunteers, and visitors to the FSD property.