Non-client Photo and Video Release Form

Disability Rights Texas (DRTx) is a nonprofit advocacy agency that provides legal services to Texas adults and children with disabilities.

Today's Date * Required
MM slash DD slash YYYY
Your Name * Required
First Last
Your Organization (if applicable) * Required
If you are participating privately and not on behalf of the organization you work for, please write N/A.
Your Title/Position (if applicable) * Required
Only need to answer this if you are participationg on behalf of an organization. Otherwise enter N/A.
Mobile number * Required
Business Direct Line
Email * Required
Enter Email Confirm Email
Are you over the age of 18? * Required
- Yes
- No
Name of Project * Required
Disability Rights Texas staff person will instruct you on what to insert in this section.
I give Disability Rights Texas permission to use photos or video footage of me for the purpose of promoting their advocacy program or project named above. * Required
(Photos and video will not be sold or used for commercial purposes by Disability Rights Texas.)
- Yes
- No