Social Media Consent Form

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* 1. Name

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* 2. Organization:

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* 3. Acknowledgements:

I grant permission for the organization named above to use photographs or videos of me and information related to my experiences with the organization on Facebook, Instagram, X, Tik Tok, or any other social media platform.

I grant permission to the organization named above to edit and alter photographs or videos of me for social media.

I grant permission for the organization above to use photographs or videos of me on social media for the purpose of marketing and advertising.

I agree that I will not receive any monetary compensation.

I confirm that I am of legal age to give my consent.

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* 4. I prefer that:

My full name be used

My first name only be used

I remain anonymous

A nickname be used: (please specify)

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* 5. I consent to the use of social media given the acknowledgements above:

I consent

I do not consent

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* 6. Signature:

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* 7. I acknowledge that by entering my name above I am providing a digital signature.

Agree

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* 8. Date

Date