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Image Release Form

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  3. Contra Costa County features video and media across a wide variety of platforms . By filling out the form below, you give the County of Contra Costa (“County”) the absolute right and permission to the unlimited use of your image and likeness in photographic, video, film, slide, or any other electronic or printed formats as follows:
  4. 1.*
    I understand and agree that the County may use my image or likeness in its educational or promotional materials, publicity efforts, or for any other lawful purpose.
  5. 2.*
    2. I understand and agree that these materials will become the property of the County and will not be returned;
  6. 3.*
    3. I understand and agree that the County shall have the right to use my image or likeness in any display, publication, print ad, direct-mail piece, or electronic media, including, but not limited to, video, online, email, or television;
  7. 4.*
    4. I understand and agree that the County’s use of my image and likeness will be without any compensation to me or my heirs or assigns.
  8. 5.*
    I authorize the County to edit, alter, copy, exhibit, publish or distribute my image or likeness for these purposes.
  9. 6.*
    I waive the right to inspect or approve the finished product in which my image or likeness appears.
  10. 7.*
    7. I release and hold harmless the County, the photographer, their officers, employees, agents, and designees from any liability, claims, demands, causes of action, or attorneys fees regarding the use of my image or likeness, including for violation of any personal or proprietary right I may have in connection with such use.
  11. I am 18 years of age or older, have read and understand this release, and agree to this release voluntarily.*
  12. Leave This Blank:

  13. This field is not part of the form submission.