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I authorize Koinonia, a public non‐profit corporation, and those acting in authority to:
a. Record my participation and appearance on video, audio recording, photographs or any other medium.
b. Use my name, likeness, voice and biographical material in connection with these recordings, publications or as
provided by me.
c. Exhibit or distribute such recordings, in whole or part, without restrictions or limitations for advertising,
recruitment, fundraising, publicity, training or any other purpose on behalf of Koinonia.
d. To sell, duplicate, reproduce and make other use of such information, with no compensation for my time and
services, waiving my personal rights to such photographs, videos, audio recordings or publications without
inspection or approval of the finished photographs, video or audio recording.
I hereby release and discharge Koinonia from any and all claims and demands arising out of or in connection with
the use of such photographs, video or audio recording, including but not limited to any claims for defamation of
invasion of privacy.
I hereby consent to the release of said photographs, video or audio recording or any other medium for the above‐
stated purposes and in accordance with the terms stated above.