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Contact
CP State Media Consent Form
Name
First
Last
Parent or Guardian (if under 18 years of age or lack competency and parent/guardian agrees)
First
Last
Date
MM slash DD slash YYYY
Media Consent/Release
(Required)
I give my permission to Cerebral Palsy Associations of New York State (CP State), including its staff, consultants, and contractors, to take and use photographs, video, and/or audio recordings of me and/or my property. I understand these materials may be used for educational or promotional purposes that support CP State’s mission, including use on websites, social media, and in printed or digital publications. I also allow CP State to use my name and identity in connection with these materials if applicable. I understand that I will not receive compensation for the use of these images or recordings, and I waive any rights to inspect or approve the final use. By checking this box, I acknowledge that I have read and understand this consent and release, and that I am legally able to provide it.
I consent to the use of my name and image.