Media Consent Opt-Out Form

Consent and Release to Photograph and/or Record and/or Refer

  • This field is for validation purposes and should be left unchanged.
  • Throughout the Certificate in Community Storytelling Training and/or Hearth workshops, webinars and retreats, whether in person or online, The Hearth, its employees, or persons hired by The Hearth may photograph, or film participants’ to refer to on our website, event postings, promotional posts on social media or grant applications. I hereby request that my photograph and/or video not be used for promotional purposes on social media platforms (such as Facebook, Instagram, Twitter) and YouTube by The Hearth, event postings on The Hearth website or grant applications. I understand that by opting out, my image and likeness will not be used in any materials related to The Hearth's activities and events, including but not limited to retreats, workshops, and gatherings. By submitting this form, I indicate my decision to opt out of the use of my photographs and videos.

    Please note: Only complete and return the form below if you wish to OPT OUT of this release.