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Multimedia & Communications Release Form

Permission for information to be used and seen by the public

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Please read and sign this Personal Information Release Form that gives Wilder permission for your and/or your child's information to be used and seen by the public. Thank you for agreeing to have your information shared on our website and through various other public channels such as social media (Facebook, Twitter, LinkedIn and YouTube).

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What information are you sharing with us? Wilder has my permission to use and let the public see my and/or my child's: (select all that apply)
Can Wilder share your name and/or your child’s name? (select one)
Please describe the purpose or event below
I understand that when I give Wilder permission to share my information:
  • This information will be seen by the public and may also be copied, printed, or used by someone else besides Wilder.
  • Wilder may share my information in printed and electronic materials and on social media.
  • I (or my child) will not get paid for the use of this information.
  • If I sign this I (and/or my child) will not have any claims for liability or for money against Wilder or against Wilder’s employees or representatives for using and having the public see this information.
  • I can change my mind at any time unless the information has already been used, given or published.
    • I must contact Wilder’s communications team in writing to say I have changed my mind about giving permission. You may email Wilder at info@wilder.org.
    • If the information has already been used, given or published, Wilder may be unable to remove or unpublish information that has already been shared. However, Wilder will not use your information for new uses after you inform us in writing that you have changed your mind.
  • My signature means that I understand what giving my permission means and that I give my permission voluntarily.
Please use the grey box below to sign this form using your mouse (if using computer or laptop) or finger (if using phone or tablet).
Please enter your contact information below.

PRIVACY NOTICE

The information you give to us in this form will be used to determine service requests and may be shared with other staff at Wilder whose jobs require access or with others outside of the Wilder Foundation as provided by law. You can also review our full privacy policy here.

Please note that you are not required to submit your information using this form. You may also contact us at info@wilder.org if you have any questions.