12. Photograph Permission

PHOTOGRAPH PERMISSION FORM

Sunrise Care Homes gathers images of residents while participating in care home activities like parties and events to acknowledge resident’s special occasion. We appreciate your cooperation and consent in allowing us to photograph you or your loved one for our use in various medium. You have our assurance that these images
will be used only with the respect and consideration to which you and your loved are entitled.
House *
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Select
Hayden
McDonald
Paradise Valley
Sunnyvale
Resident Name *

Resident’s Representative *

Email *

Phone *

Address *

Street Address

Street Address 2

City

State

Zip

I, , hereby voluntarily and without compensation grant permission to Sunrise Care Homes for full use, without restriction of any kind, of the photographic/video image(s) taken of me, or of anyone for whom I have legal responsibility, on this date, for any publication, presentation, exhibit, video, or other print or digital format. I further grant to Sunrise Care Homes full rights to republish, without time restriction, these images in Sunrise Care Homes’s publications and reports. I further extend my permission to Sunrise Care Homes to provide these images to the media for any marketing purpose.

Signature *

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Date *