Photo/Video Release

Photo Release Form

I hereby authorize the Organization - California Association of Licensed Midwives - to use, reproduce, and/or publish photographs and/or video that may pertain to me - including my image, likeness without compensation.

I understand that this material may be used in various publications, public affairs releases, recruitment materials, broadcast public service advertising (PSAs) or for other related endeavors.

This material may also appear on the Organization's or project sponsor's Internet Web Page or social media sites, including but not limited to Facebook, Pinterest, Twitter or Instagram.

I approve the use of the finished photograph by the Organization only for non-commercial, non-profit purposes, as long as I and my child remain unidentifiable and anonymous, including in the image itself and in any meta-data (including but not limited to the file name, caption, keywords, GPA coordinates, social media tagging, etc.). I disapprove of any other use of the photograph, including (but not limited to) any commercial use or resale or relicensing of the photograph (or any variation thereof) by the Organization and/or to any other party.

I have permission from the photographer to share the use of this photo with the Organization.

This authorization is continuous and may only be withdrawn by my specific rescission of this authorization, which may be retroactive.

Photo/Video Release Form


  • Max. file size: 256 MB.
  • MM slash DD slash YYYY