Recover Revolution Media Release Form 

I, _______________________________, hereby grant permission for Recover Revolution NJ to capture and use media content that includes my name, voice, image, and/or likeness in connection with their services, events, and activities. I understand and agree that this release applies to any form of media, including but not limited to photographs, videos, audio recordings, and text, and covers usage on various platforms, including social media, websites, print materials, and any other media outlets. 

I authorize Recover Revolution NJ to record, capture, and edit media content of myself while participating in its services, events, or activities. I grant Recover Revolution NJ the right to use, reproduce, distribute, display, and publish such media content for any lawful purpose, including but not limited to promotional, educational, and informational materials. I waive any right to compensation, royalties, or ownership of the media content that may be created in connection with my participation in Recover Revolution NJ's services, events, and activities. 

I affirm that I have the legal authority to grant these rights, and the information provided in this form is accurate. 

This release shall remain in effect indefinitely, unless I revoke it in writing by contacting Recover Revolution NJ at Robby@RecoverRevolutionNJ.org 

Checkboxes

Name (Please Print): Client first nameClient last name

Signature: Signature

Date: Date