Photo & Video Release Form

Photo Release

Please fill out the photo release form if you are appearing on camera for any activities at Fred Brown Recovery Services, and you agree to allow the use of your photo and / or video and / or audio.

Photo Release

PHOTO RELEASE
Permission to Use Photograph, Video and Audio

I understand that confidentiality is protected under federal regulations which govern and protect the confidentiality of substance abuse disorder clients.

Whether or not I am a client or family member and notwithstanding my rights under the law:

  • I consent and grant to Fred Brown Recovery Services, its representatives, and employees the right to use my name and likeness in both still photographs, and video with or without sound in connection with or without other clients and staff depicting my participation and activities associated with the Fred Brown Recovery Services treatment program. I authorize Fred Brown Recovery Services, its assignees, and transferees to copyright, use and publish the same in print and/or electronically.
  • I consent and agree that Fred Brown Recovery Services may use such photographs, video and audio of me with or without my name and for any lawful purpose, including for example such purposes as publicity, promotion, illustration, testimonials, advertising, and internet web content.

I have read, understand and agree to the above:

Name
Name
First
Last
Type your full name below to serve as your signature agreeing to this form. A copy of this will be emailed to the email address you provide above.