Photo/Information Release

I herby grant permission for City Union Mission to use my photograph and/or video and/or information about me for the purpose of publications, promotion or any other use they deem necessary. I understand my photograph/video/information about me may be used for fund raising purposes. I understand that I cannot expect compensation for use of these photos or stories.

*By completing the fields below, you are electronically signing this form

Today's date (MM/DD/YY) *

Full Name *

First

Last

Parent/Guardian Full Name

First

Last

If under 18, please provide full name of parent or guardian

Email *

Phone Number *

(XXX) XXX-XXXX

Description of photo/other including this party: *

Submit