JCA Photo Release

Please fill out the form below or print the photo release and return to the director of your program.

Jewish Council for the Aging® (JCA) Photo Release

By entering my name below, I hereby agree that the Jewish Council for the Aging® (JCA) may take photographs/video/audio of me and use them in newspapers, newsletters, magazines, annual reports, and brochures, as well as on television, the JCA website, social media and in other media, including those of other organizations, without restrictions or time limitations. My name on this form also indicates my consent to access and participate in virtual programs, which may be recorded and used for JCA teaching or marketing purposes, including those of other partner organizations, without restrictions or time limitations.

Choose the JCA program you are participating in:(Required)

Name (first and last)(Required)

Permission for use of name(Required)

I permit the use of my name when using my image/voice

I do not permit the use of my name when using my image/voice

Today's Date(Required)

Download the PDF for printing

Photo Release PDF