Your story can inspire hope and change lives.
This form gives San Diego Rescue Mission permission to use your testimonial, photos, videos, and other media while explaining how your information may be used and the permissions you grant.
Testimonial, Photo & Media Authorization and Release
I give San Diego Rescue Mission (SDRM) permission to use my name, testimonial, photograph, video, voice, image, and likeness (Authorized Information) to support the Mission’s communications, fundraising, education, outreach, and promotional efforts. SDRM may use Authorized Information in print, online, social media, video, email, television, and other media.
Acknowledgment and Consent
By signing below, I understand and agree that:
- This authorization may include information protected under HIPAA, CMIA, and other privacy laws.
- Signing this form is voluntary and will not affect my services or participation with the SDRM programs.
- Once shared, information disclosed may no longer be protected by privacy laws.
- SDRM may edit, reproduce, publish, and distribute the Authorized Information without my approval.
- I understand the SDRM may identify me as a participant in or supporter of its programs and services.
- I waive the right to review or approve the finished materials and to receive compensation or ownership rights for their use.
- This authorization expires ten (10) years from the date signed below. I may revoke it in writing at any time, but revocation will not affect prior authorized use.
- I release and hold harmless the SDRM from any claims arising from the authorized use of the Authorized Information.
- I certify that I am at least 18 years old and legally authorized to sign this release. If signing for a minor, I certify that I am the parent or legal guardian and have authority to do so.
San Diego Rescue Mission
120 Elm Street
San Diego, CA 92101
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