I give Lutheran Life Villages permission to photograph, film, and record me, and to use my image, likeness, voice, name, and any statements I make.

Lutheran Life Villages may use, edit, publish, and share this material in any format and in any media, now or in the future. This includes newsletters, brochures, annual reports, news releases, advertising, signage, websites, email, social media, videos, fundraising and donor materials, grant applications, recruitment and educational materials, and internal communications.

These uses may be for promotional, marketing, informational, educational, or fundraising purposes related to the mission and work of Lutheran Life Villages. Lutheran Life Villages may also share this material with media outlets, vendors, and partner organizations working on its behalf.

All photos, video, and recordings remain the property of Lutheran Life Villages. I do not have the right to review or approve them before or after they are used, and I will not receive payment, credit, or any other compensation.

I release Lutheran Life Villages from any claims related to the use of this material, including claims involving privacy, use of my likeness, defamation, or how an image is cropped, edited, or combined with other content.

I understand my care, services, residency, or employment at Lutheran Life Villages does not depend on signing this form, and that choosing not to sign will not affect the care or services I receive.

I am 18 or older and able to sign this form, or I am the parent, guardian, or legal representative of the person named below and am authorized to sign for them.

If signing for someone else