2025 Media Consent Form

Dear Participant, 

I am writing to inform you that School-Based Health Care will be conducting an event titled “Medical Assistance Apprenticeship Presentation and Orientation Program” on June 12, 2025, as part of our promotional and documentation activities. We may capture and use photographs, audio recordings, and/or video recordings during the event. 

We want to seek your consent to use your image, voice, and likeness in photographs, audio recordings, and/or video recordings taken during the event for the following purposes: 

1. Promotional and marketing materials related to HCIS (School-Based Health) and its activities. 
2. Inclusion on our official website, social media channels, and other promotional platforms. 
3. Documentation and archival purposes related to the Medical Assistance Apprenticeship program and its success. 

By signing this letter, you grant HCIS (School-Based Health) the right to use your image, voice, and likeness for the purposes mentioned above. You understand that these materials may be used in perpetuity and without any compensation to you. 

If you do not wish to grant such consent, please let us know in writing before the event or on the day of the event. 

Please review the consent form below and sign to signify your agreement.

Thank you for your cooperation and support. If you have any questions or concerns, please feel free to contact us at info@hciswellness.org  

Sincerely, 

Dr. Edna Miller Ed. Psy  
Apprenticeship Director