Enhancing quality of life by empowering individuals and strengthening communities.

Media Release Form

Instructions for completing the below electronic media releases:

  1. Complete one release for each individual to be shown in an image or video. 
    1. You may only complete the release for yourself or a minor you are the parent/guardian of. 
    2. Each adult will need to complete their own release.
    3. EVERYONE displayed in a video created and shared by our staff will need a valid media release.
  2. By completing the below form you grant permission to NEMCSA to use your name, image and/or voice in any of NEMCSA’s electronic, print or multimedia publications (including but not limited to agency online/web content, social media outlets, agency annual reports and any other print or electronic publications by NEMCSA) and you agree that you will make no monetary or other claim against NEMCSA relating the use of your name, image and/or voice. This release will remain active until revoked in writing by either party.