Please fill out and sign the photo release agreement form by downloading the form from button, print out and forwarding or
by filling out this form on this page, submitting with your electronic signature.

RELEASE FORM

First name

Last name

, am of legal age. By signing this release form, I hereby consent to and authorize C&S Charities, Inc., C&S Wholesale Grocers, LLC, its subsidiaries and affiliates (collectively the “Company”) and the Company’s assigns and transferees, to use, publish and reproduce, for all purposes, my name, recordings, including sound and video recordings of me and my voice, and pictures of me in film, photographic, digital or electronic form –

including, without limitation, use, publication and broadcast with name, no name or a fictitious name; use in the form taken or with intentional or unintentional alterations; and use for the purpose of publicity, illustration, commercial art, social media and in the advertising of any product, activity or services. All negatives, positives, photos, videotapes, and other recordings of me taken by the Company, shall constitute the property of the Company.

I acknowledge that I have read the foregoing and I fully understand the contents.

Address

Phone