Community Photo Release Form

Photo Release (required)

I hereby grant permission to Grossmont Healthcare District to use and share photographs and/or video taken of myself on the event date I enter below in publications, news, and releases, whether online or in other communications, related to our mission. Furthermore, I grant creative permission to alter the photograph(s).

Date of Event (if known) (required)

Name/Title of Event (required)

Name of Event Participant (First and Last Name) (required)

Full Name of Guardian (if under age 18): (First and Last Name)

Phone Number (required)

Email Address (required)