Foundation for Foster Children Photo/Testimony and Release of Information Consent to ServicesThis consent to services form grants permission to the Foundation for Foster Children to provide services and release information to necessary parties for the implementation of services. Consent to Services I do give consent I don't have permission to provide consent Please provide the name, phone and email address of the individual with permission to provide/deny photo consent.* Media/Photo Consent Form and TestimoniesThis consent and release form grants permission to Foundation for Foster Children for the use of testimonies, photograph(s) or electronic media images. Images will be stored in a secure location and only authorized staff will have access to them. They will be kept as long as they are relevant and after that time archived. Media/Photo/Testimonies consent forms and release will expire may 1st of 2024, unless: *Child turns 18, new consent form will be required *Change in placement for children under 18, new consent form will be required with current legal guardian signature. *Legal guardian/child/young adult choices to withdraw their consent for any reasons.Date* MM slash DD slash YYYY Youth First Name* Youth Last Name* Youth Email* Date of birth Month Day Year For youth 0-17, have parental rights been terminated?* Yes No Unknown N/A: Youth is 18 or older Relation to the Youth* Self (Youth over 18) Caregiver IL Specialist/TSS Case Manager/Caregiver Support GAL If the picture/testimony is of a minor, child permission to use the material must be provided by a parent, caregiver, IL Specialist/TSS, Case Manager/Caregiver Support, or GALPhoto/Testimony Consent* I do give consent I do not have permission to provide consent Please provide the name, phone and email address of the individual with permission to provide/deny photo consent.* Media/Photo Consent Form and Testimonies By signing below, I hereby give the Foundation for Foster Children (FFC) permission to use my photograph and use an approved story in FFC marketing materials including, but not limited to, the website and print materials of FFC. I understand that I will not receive compensation for the use of this likeness in any form.Electronic Signature: Media/Photo Consent Form, Testimonies and Release of Information* Please type first and last nameElectronic Signature: Media/Photo Consent Form, Testimonies and Release of Information* By checking this box you accept this electronic signature.
