Media Consent Form (Optional and Confidential) I/We hereby

HUI MĀLAMA O KE KAI FOUNDATION
Media Consent Form (Optional and Confidential) I/We hereby consent to allow the Hui Mālama O Ke Kai Foundation to take pictures of
my/our child and other members of our family during Hui Mālama O Ke Kai Program
activities for the purpose of program documentations, community education and/or public
relations.
I/We hereby consent to allow the Hui Mālama O Ke Kai Foundation to make a video or
audio recordings of my/our child and other members of our family during Hui Mālama O
Ke Kai Program related activities for the purposes of program documentations, community
education and/or public relations.
These photographs, videos, or audio recordings may be used in newsletters, newspaper
articles, presentations, calendars or posters, program materials and documentations,
and/or for other similar uses.
I understand with full knowledge that these photographs, videos, and/or audio recordings
are the property of the Hui Mālama O Ke Kai Foundation.
List all family members that may be covered by this consent form.
Parent: Please sign the very bottom for all minors noted on this consent form.
Participant’s
Name:
Participant’s Signature
Participant’s
Name:
Participant’s Signature
Participant’s
Name:
Participant’s Signature
Participant’s
Name:
Participant’s Signature
Participant’s
Name:
Participant’s Signature
Participant’s
Name:
Participant’s Signature
Participant’s
Name:
Participant’s Signature
Participant’s
Name:
Participant’s Signature
Participant’s
Name:
Participant’s Signature
Parent’s Signature:
Date:
*If 18 years old & over.
*If 18 years old & over.
*If 18 years old & over.
*If 18 years old & over.
*If 18 years old & over.
*If 18 years old & over.
*If 18 years old & over.
*If 18 years old & over.
*If 18 years old & over.
*This consent m ay be w ithdrawn at anytime by contacting the Program M anager at 259-­‐2031. Rev. 11/15