Photo/Video Consent and General Release Form

First Name

Last Name

Subject

Program

2023 Adventure Weekend Retreat - June 2-4

Message

I hereby authorize the Betty J. Borry Breast Cancer Adventure Weekend, Inc. d/b/a/ the Betty J. Borry Breast Cancer Retreats to use pictures of me taken in a photograph, digital image, videotape, motion picture, and/or testimonial (written words). The undersigned hereby releases the Betty J. Borry Breast Cancer Adventure Weekend, Inc. d/b/a/ the Betty J. Borry Breast Cancer Retreats, its agents or employees, as well as any and all users and exhibitors of said pictures, from any and all claims, demands, accountings, and causes for which the aforesaid videotape, testimonial, motion picture, digital image, or photograph likeness may be used pursuant to this Consent and General Release. It is also my understanding that I will receive no compensation for my likeness or testimonial.

BJBBCR Social Media Photo/Video Policy June 2019

Still photos of BJBBCR retreat group discussions are acceptable for posting on your personal profile, the BJBBCR public page, and the BJB Adventure Women private group. Video recordings of sensitive and private group discussions whether posted on personal, public, or private Facebook pages/groups are NOT appropriate for respect of everyone's privacy and mutual trust. A pre-arranged, consented video interview with an individual or group of participants is acceptable when posted by a BJBBCR administrator on our Facebook platforms (BJBBCR public page and BJB Adventure Women private group) or the BJBBCR website. When in doubt about sensitive and private content, please contact BJBBCR social media administrators before posting on social media.

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Betty J. Borry Breast Cancer Retreats 21 Littlehale Road Durham, NH 03824