HLAA 2023 Release Form

HLAA uses and shares video, photographs and narrative stories.

The video and photographs, and written stories both edited and unedited, are intended to be used: 

1. For educational purposes. For example, your content may be used as a learning tool.  This content might be publicly posted.
2. To promote HLAA and our programs. These images and other content may be posted to the HLAA website, YouTube, in the HLAA e-News and on social media and will include your full name, unless otherwise stipulated.

Your permission is voluntary. If you have questions or concerns, please contact Teri Breier at tbreier@hearingloss.org.

I hereby grant permission to HLAA representatives, to take and use photographs and/or videos of me, or my written, narrative story for either education purposes or to promote HLAA. These uses may include printed or electronic publications, websites or other electronic communications. I further agree that my name and identity may be revealed in descriptive text or commentary in connection with the narrative stories, photograph(s) and/or video(s). I authorize the use of this media without compensation to me. All narrative stories, video and photographs shall be the property of HLAA.