Media Release Form

Name of participant or volunteer*

I hereby grant to you, Home Run Hitters International Incorporated, the right to use the image / voice of (name of participant or volunteer in box above), for advertising, sharing program information and developing program support.
It is also understood that any such materials (video, film, photos, audio, and any other media) will be used with the highest integrity, with the intent to communicate responsibly and ethically, the matters relating to the organization’s commitment to persons with special needs, their families, educators and care providers. It is also understood that personal identifying information will not accompany any of the media used in educational or professional development forums, marketing efforts including its use on the web and other social media like Face Book, Instagram, and Twitter.

Please fill out the following information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

If 18+, please place name below (acting as a signature)

If under 18, please place parent/guardian name below (acting as a signature)

*Home Run Hitters International Incorporated is a Non-Profit tax exempt Organization 1)Meeting the challenges of individuals whose disabilities impact their abilities and opportunities to successfully interact or communicate and 2) Supporting their families, educators and care providers. Current Programs: Camp M.I. Way, Switch A Thon, Home Run Hitters Club, HRH Away Weekends

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