Consent and Release Form

I, the undersigned, for myself or as the parent or legal guardian of the below-named minor child or other individual unable to give consent, grant to Goodwill Industries of Northwest North Carolina, Inc. (“Goodwill”) all right, title, and permission to create, use, edit/alter, copy, publish and display material containing my name, image, voice or likeness (“Material”) for any lawful purpose, and in any and all media including digital/internet/print use, without payment or any other consideration or credit to me. Material includes:

  • Photographs and negatives
  • Reproductions and copies of original photographs
  • Drawings and artistic renderings
  • Audio, video, or multimedia recordings
  • Biographical material, written word/transcripts, or stories supplied by me or written about me
  • In addition, I waive any right to inspect or approve any finished product incorporating the above Material.

This Consent and Release Form shall remain in effect unless and until revoked in writing sent to Attn: Communications Manager, Goodwill Industries of Northwest North Carolina, Inc., 2701 University Parkway, Winston-Salem NC 27105 or by email at I understand that if I revoke this consent, my revocation will not have any effect on actions already taken by Goodwill in reliance on this consent.

I further release, waive, and hold Goodwill harmless from all claims, demands, and causes of action, including those related to publicity, copyright, or moral rights, this I or my representatives, heirs, and assigns may have now or in the future.

By completing the form and checking the box below, I certify that I have read and understand this Consent and Release Form, am 18 years of age or older, have been given the opportunity to have my questions answered, and that Goodwill will provide me with a copy of this consent upon my request.