Photo & Media Release Form — SAMPE Foundation

This release covers photographs and video taken at SAMPE Foundation-sponsored events, programs, and activities. Media may be used in print, digital, and social media publications. For questions, contact foundation@sampe.org or call (949) 433-1331.

Photo & Media Release

✓ Your release form has been submitted successfully. Thank you! A copy has been sent to your email address.

Release Type

This release is for *

Subject Information

Subject First Name *

Subject Last Name *

School / Organization

Grade / Age (if minor)

Program / Event *

Person Completing This Form

Your Full Name *

Your Email Address *

Your Phone Number

Today's Date *

Authorization: I hereby grant the SAMPE Foundation permission to photograph, video record, and use images and/or video of the subject named above in connection with SAMPE Foundation programs and activities. I authorize the SAMPE Foundation to use, reproduce, and distribute these materials in print publications, the SAMPE Foundation website, newsletters, social media, grant applications, and other promotional or educational materials — with or without the subject's name. This authorization is granted without compensation and is non-exclusive. I understand I may revoke this release at any time by contacting foundation@sampe.org.

I have read and agree to the authorization statement above. By submitting this form I confirm my consent. *

Need to submit a release for multiple students? Please complete one form per person. Questions? foundation@sampe.org · (949) 433-1331