Photo Release Form

Photo Release*
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)
MM slash DD slash YYYY
Name/Title of Event*
Name of Event Participant*
First Last
Full Name of Guardian (if under age 18):
First Last
Phone Number*
Email Address*