This Publication Release form asks your permission for Holt International Children’s Services to publish photo (or video) in which you appear (especially, but not limited to, group photos), or photos which you take and send to us for publication. Holt may or may not actually publish any of the photos. If you have concerns about this we can ask your permission at the time we are preparing to publish a particular photo.
I, the undersigned, hereby consent to the reproduction, use, and/or exhibition of my photograph(s) or videotape of me by Holt International Children’s Services, Inc. (“Holt”). I further release Holt from any and all claims for damages for libel, slander, invasion of privacy, or any other claim based on use of the above described materials. The consideration for this release is other than money, the sufficiency and receipt of which is hereby acknowledged by the undersigned. Neither Holt nor anyone associated with Holt has made any promise of any other compensation in relation to this release. This release extends to the employees, agents, licensees, successors, and assignees of Holt.
In the fields below, please indicate which information you authorize Holt International to use in the above described materials in the following manner. Please mark either “yes” or “no” in all boxes that apply to you.