Release

I agree that any photograph(s), audio or video recording(s) taken of me during a publicity interview by a representative of Jewish Family and Community Services (JFCS) of Pittsburgh will become property of JFCS.

I understand that the photograph(s), video(s) and/or testimonial copy is/are being taken for use in agency publications and/or website including, but not limited to, the JFCS Annual Report, social media pages, agency websites or other agency publicity.

By signing this release, I give permission to JFCS to use my photograph(s), audio/video(s) or contents of an interview or written testimonial provided by me in agency or other publications at their discretion and agree to allow the distribution of this information to the media. This also includes the use of my name as listed in my signature.

I am participating voluntarily and I discharge JFCS, its affiliates, and their officers, directors, employees, volunteers and independent contractors, from any liability related to the use of photograph(s), audio/video(s) or contents of an interview or written testimonial provided by me, including but not limited to in the event that any personal or confidential information is disclosed.

I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.

I understand that I will not receive any special services or compensation in exchange for my agreeing to sign this authorization. I understand that I may revoke this authorization at any time by providing written notice to JFCS addressed to: JFCS Communications Department, 5743 Bartlett Street, Pittsburgh, PA 15217. However, such revocation shall not affect JFCS’s right to use information, photography/recording(s), and/or interviews made or obtained prior to my revocation of this authorization.

Release Form

• For written testimonials only:
  • The information provided and testimonial attached, including my name and any personal information I disclosed about my experience with JFCS has been reviewed by me and may be duplicated in promotional material or distributed to the media
  • The information provided has been done so with the intention to remain anonymous and should only contain information I disclosed about my experience with JFCS, and not my name nor that of my family members. The testimonial has been reviewed by me and may be duplicated in promotional material or distributed to the media.
• Please select the paragraph below which is applicable to your present situation:
  • I am 18 years of age or older.
  • I am the parent or legal guardian of the below named child.
• Name
• Date
  MM slash DD slash YYYY
• Address
• Email
• Phone