Authorization to Use Audio/Video Recordings, Photographs & Information

NDRN Authorization Form

This is a digital version of the standard consent form used by the National Disability Rights Network (NDRN).

I hereby give permission to the National Disability Rights Network (NDRN) to publish audio recordings, photographs and video footage taken of me, and all other printed or electronic matter for accessibility and publicity purposes including, but not limited to, providing information in accessible formats, NDRN annual reports and newsletters, websites, social media platforms, and press releases that show the kind of work done by NDRN. NDRN will not sell or otherwise use this material for commercial purposes. I agree that for accessibility and publicity purposes, NDRN may (check all that apply):*
- reproduce, use, exhibit, display, broadcast, distribute and create derivative works of these photographs and/or video footage, or other photographs and videos which I have given to NDRN, in any media now known or later developed;
- use my name and;
- use information about the assistance that a NDRN member agency provided me and/or my child or ward.
I hereby waive any right to inspect or approve the final product (printed or electronic matter) that may be used in conjunction with these audio recordings, photographs and video footage now or in the future, whether that use is known to me or unknown. I hereby agree to release, defend, and hold harmless NDRN and its officers, directors, employees, agents or third parties, and all persons acting under NDRN’s permission or authority, including any firm publishing and/or distributing the finished product in whole or in part, whether on paper or via electronic media, from and against any claims, damages or liability arising from or related to the use of the photographs and/or videos, including but not limited to any misuse, distortion, blurring, alteration, either intentionally or otherwise, that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution.
Name*
First Last
Parent/Guardian (only if applicable)
First Last
Email Address

If you have any questions, please contact [email protected].