I grant Rise Recovery permission for my image, likeness and sound of my voice as recorded on video tape to be captured during regular and special Rise Recovery activities and/or events, without payment or any other consideration. I understand that my image may be edited, exhibited, published or distributed and waive the right to inspect or approve the finished product in which their likeness appears. Rise Recovery will only use media to support the mission.

Photographic, audio or video recordings may be used for the following purposes:

·         Conference presentations
·         Educational presentations and/or videos
·         Informational presentations and/or videos
·         Promotional materials
·         Fundraising purposes
·         Publications

By signing this release I understand that participation is completely voluntary. By signing this release I understand that this permission signifies that photographic or video recordings may be electronically displayed via the Internet or in the public setting.

I will be consulted about the use of my photographs or video recordings for any purpose other than listed above.

There is no time limit on the validity of this release nor is there any geographic limitation on where materials may be distributed.

By signing this form I acknowledge that I have completely read and fully understand the above release terms and agree to be bound thereby. I hereby release any and all claims against any person or organization that may use this material.

By submitting this form you are indicating that you have read this release form, are over the age of 18, and that you agree to the terms as described.

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* 1. I agree to allow Rise Recovery the use of my image, likeness and sound of my voice as indicated in the release. I am participating voluntarily.

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* 2. Please type your name in the box below to indicate your agreement.