Consent Form

Please complete one form per participant/volunteer.

I hereby give my permission for the Grahamtastic Connection and/or its representatives to use artwork, photographs and/or letters that I provide of my child, my family, or myself in publications, slides, videotapes, motion pictures or on the Internet. In addition, I hereby give my permission for the Grahamtastic Connection and/or its representatives to photograph, audio tape record, or videotape my child or myself and to use our names, these images or voice recordings in publications, slides, videotapes, motion pictures or on the internet.

I understand these visual images or voice recordings may be used to inform families, volunteers, donors, the media and general public about Grahamtastic Connection programs, services or events.

Signing the consent form is not a requirement in order to receive assistance from the Grahamtastic Connection.

Name/Child's Name:

Date of Birth:

Street Address:

City: State: Zip:

Phone: Cell: Fax: (xxx-xxx-xxxx)

Email:

Signature (parent/guardian signature required for minors)

I gladly give this authorization to support the efforts of the Grahamtastic Connection. I understand this authorization shall continue until terminated in writing.

After clicking on the Send Info button, an email will open, you must hit Send to submit the form.