Consent Form:

I consent to the reproduction and/or use of photographs/artwork/interviews of myself (or my child if under 18 years old) – with or without the use of my name(s) – by Interface Children & Family Services and by any nominee or designee of Interface (including any agency, client, media outlet, periodical or other publication).

The photo/artwork/interview/name(s) may be used in all forms, media, and manners, including advertising, trade, display, editorial, art, video, exhibition and Internet.

In giving this consent, I release Interface, and their nominees and designees from liability for any violation of any personal or proprietary right I may have in connection with such reproduction or use. I also waive any rights to compensation for use of this material.

Signature of adult whose photograph/interview is being used.
If individual whose photograph/artwork/interview is being used is under 18 years old, signature of parent or legal guardian must be obtained.