FORMS

Photo and Video Release Form

Life Path Institute LLC, “Van of Promise”
286 Montevue Ln
Frederick Md 21702

Permission to use Photograph/Video

Subject's Name

Location Where Photo/Video Takes Place:

Agreement:

I have read and understand the following:

I grant to (Martina Duncan), its representatives and employees the right to take photographs/video of me and my property in connection with the above-identified subject. I authorize Life Path Institute, its assigns and transferees to copyright, use and publish the same in print and/or electronically.

I agree that (Martina Duncan) may use such photographs/video of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, social media and website content.

Signature of Subject (sign with finger, mouse, or track pad):

Printed Name

Organization Name

Address 1

Address 2

City

State

Zip Code

Signature of Parent or Guardian if Subject is under 18 (sign with finger, mouse, or track pad):

FORMS

Photo and Video Release Form

Permission to use Photograph/Video

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