{"id":368,"date":"2023-05-18T16:07:59","date_gmt":"2023-05-18T16:07:59","guid":{"rendered":"https:\/\/communitycare-odu.com\/?page_id=368"},"modified":"2023-05-18T16:21:40","modified_gmt":"2023-05-18T16:21:40","slug":"media-release-form","status":"publish","type":"page","link":"https:\/\/communitycare-odu.com\/?page_id=368","title":{"rendered":"Media Release Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"368\" class=\"elementor elementor-368\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-40553cfc elementor-section-height-min-height elementor-section-content-middle elementor-section-full_width elementor-section-stretched elementor-section-height-default elementor-section-items-middle\" data-id=\"40553cfc\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;stretch_section&quot;:&quot;section-stretched&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-7de89177\" data-id=\"7de89177\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-34e6839f\" data-id=\"34e6839f\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8af7baa elementor-invisible elementor-widget elementor-widget-heading\" data-id=\"8af7baa\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;motion_fx_motion_fx_scrolling&quot;:&quot;yes&quot;,&quot;_animation&quot;:&quot;fadeInDown&quot;,&quot;motion_fx_devices&quot;:[&quot;desktop&quot;,&quot;tablet&quot;,&quot;mobile&quot;]}\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Media Release Form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-66 elementor-top-column elementor-element elementor-element-2d5c6f94\" data-id=\"2d5c6f94\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-02bdd7c elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"02bdd7c\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-138b2d0\" data-id=\"138b2d0\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b6f7f68 elementor-widget elementor-widget-wpforms\" data-id=\"b6f7f68\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-370\"><form id=\"wpforms-form-370\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"370\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F368\" data-token=\"1e4430b3d2c84140e23b2d19bdb8283c\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-370-field_9-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-370-field_9\">I hereby agree to the following terms: <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-370-field_9\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-370-field_9_1\" name=\"wpforms[fields][9][]\" value=\"The undersigned agrees to give permission to Old Dominion University to use their image in video and\/or photography for the purpose of publicizing ODU, ODU Community Care and ODU School of Nursing in any general University promotions, which could include the University Web site; publications which include the print admissions package, brochures, magazines, video, television, newspaper, newsletters, and\/or publications that may act as fundraising ventures for ODU Community Care and the School of Nursing. The photo\/video may or may not contain a caption identifying any individuals, although one may occasionally accompany the picture.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-370-field_9_1\">The undersigned agrees to give permission to Old Dominion University to use their image in video and\/or photography for the purpose of publicizing ODU, ODU Community Care and ODU School of Nursing in any general University promotions, which could include the University Web site; publications which include the print admissions package, brochures, magazines, video, television, newspaper, newsletters, and\/or publications that may act as fundraising ventures for ODU Community Care and the School of Nursing. The photo\/video may or may not contain a caption identifying any individuals, although one may occasionally accompany the picture.<\/label><\/li><\/ul><div class=\"wpforms-field-description wpforms-disclaimer-description\">1. YOUR AGREEMENT<br \/>\r\n<br \/>\r\nBy agreeing to this media release form, you agree to be bound by, and to comply with, these Terms and Conditions. If you do not agree to these Terms and Conditions, please do not use tick the box.<br \/>\r\n<br \/>\r\n    PLEASE NOTE: We reserve the right, at our sole discretion, to change, modify or otherwise alter these Terms and Conditions at any time. Unless otherwise indicated, amendments will become effective immediately. Please review these Terms and Conditions periodically.<\/div><\/div><div id=\"wpforms-370-field_11-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-trigger\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-370-field_11\">The Media Can Be Used in the Following: <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-370-field_11\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-370-field_11_1\" name=\"wpforms[fields][11][]\" value=\"Videos\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-370-field_11_1\">Videos<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-370-field_11_2\" name=\"wpforms[fields][11][]\" value=\"Photos\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-370-field_11_2\">Photos<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-370-field_11_3\" name=\"wpforms[fields][11][]\" value=\"Email Marketing\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-370-field_11_3\">Email Marketing<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-370-field_11_4\" name=\"wpforms[fields][11][]\" value=\"Social Media\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-370-field_11_4\">Social Media<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-370-field_11_5\" name=\"wpforms[fields][11][]\" value=\"Newsletters\/Magazines\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-370-field_11_5\">Newsletters\/Magazines<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-370-field_11_6\" name=\"wpforms[fields][11][]\" value=\"Website\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-370-field_11_6\">Website<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-370-field_11_7\" name=\"wpforms[fields][11][]\" value=\"Other\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-370-field_11_7\">Other<\/label><\/li><\/ul><div class=\"wpforms-field-description\">Tick all that apply<\/div><\/div><div id=\"wpforms-370-field_12-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"12\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-370-field_12\">If other, please specify<\/label><input type=\"text\" id=\"wpforms-370-field_12\" class=\"wpforms-field-medium\" name=\"wpforms[fields][12]\" ><\/div><div id=\"wpforms-370-field_10-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-370-field_10\">Signature of Individual to be Photographed\/Videoed  <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-370-field_10\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][10]\" autocomplete=\"off\" required><div class=\"wpforms-signature-wrap wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-370-field_10-signature\" data-color=\"#000000\"><\/canvas><button class=\"wpforms-signature-clear\" title=\"Clear Signature\">Clear Signature<\/button><\/div><\/div><div id=\"wpforms-370-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><label class=\"wpforms-field-label\" for=\"wpforms-370-field_0\">Print Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-370-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" required><label for=\"wpforms-370-field_0\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-370-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" required><label for=\"wpforms-370-field_0-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-370-field_17-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-trigger\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-370-field_17\">Is the person to be photographed\/videoed under 18 years of age? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-370-field_17\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-370-field_17_1\" name=\"wpforms[fields][17][]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-370-field_17_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-370-field_17_2\" name=\"wpforms[fields][17][]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-370-field_17_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-370-field_15-container\" class=\"wpforms-field wpforms-field-signature wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"15\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-370-field_15\">Signature of Parent if Individual is under 18 years of age <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-370-field_15\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][15]\" autocomplete=\"off\" required><div class=\"wpforms-signature-wrap wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-370-field_15-signature\" data-color=\"#000000\"><\/canvas><button class=\"wpforms-signature-clear\" title=\"Clear Signature\">Clear Signature<\/button><\/div><\/div><div id=\"wpforms-370-field_16-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"16\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-370-field_16\">Print Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-370-field_16\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][16][first]\" required><label for=\"wpforms-370-field_16\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-370-field_16-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][16][last]\" required><label for=\"wpforms-370-field_16-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-370-field_14-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"14\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-370-field_14\">Date <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-370-field_14\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][14][date]\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-370-field_13-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"13\"><h3 id=\"wpforms-370-field_13\" name=\"wpforms[fields][13]\">Contact Information<\/h3><\/div><div id=\"wpforms-370-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-370-field_1\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-370-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-370-field_8-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-370-field_8\">Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-370-field_8\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][8]\" required><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"370\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"4\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-370\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" src=\"https:\/\/communitycare-odu.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Media Release Form<\/p>\n","protected":false},"author":4,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"inline_featured_image":false,"_monsterinsights_skip_tracking":false,"footnotes":""},"class_list":["post-368","page","type-page","status-publish","hentry"],"aioseo_notices":[],"aioseo_head":"\n\t\t<!-- All in One SEO 4.9.10 - aioseo.com -->\n\t<meta name=\"description\" content=\"Media Release Form Please enable JavaScript in your browser to complete this form.I hereby agree to the following terms: *The undersigned agrees to give permission to Old Dominion University to use their image in video and\/or photography for the purpose of publicizing ODU, ODU Community Care and ODU School of Nursing in any general University\" \/>\n\t<meta name=\"robots\" content=\"max-image-preview:large\" \/>\n\t<link rel=\"canonical\" href=\"https:\/\/communitycare-odu.com\/?page_id=368\" \/>\n\t<meta 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