PROMOTIONAL/TRAINING RELEASE	Date
Client	Meeting Date with Client
Staff	Meeting Date with WSC
Go over each the release with the client and his guardian at intake and when there is a need for promotional or training purposes ONLY if needed. Do NOT have the client/guardian/advocate sign until needed.
Release for Promotional/Training Purposes

The individual client/guardian/advocate hereby authorizes the release and use of digital/non-digital reproductions in the form of interviews, photographs/photo reproduction, audio, video, sound, and/or print of the individual client/guardian/advocate which the individual knows may or may not be used in a format that may be seen, read, or heard by staff and/or the general public for the purpose specified for an indefinite period of time and which may be used for promotional and/or training purposes.
Individual Client (print)

Purpose of release (check one)
Promotional Purpose(s)
Training Purpose(s)
Form in which the information is to be released and/or used (check all that apply)
An interview with the individual client with or without audio and/or sound
A photograph or photo reproduction of the individual client
A video of the individual client
An audio tape or recording of the individual client
Scenarios with the individual in them using photographs/photo reproductions, video, audio, sound, and/or print
A digital or non-digital reproduction of the individual client in any form (audio, sound, video, photo, print)
Other (specify)
The release for promotional/training purposes request is authorized for thirty (30) days from the date of signature.

Individual	Signature	Date
Client
Guardian
Advocate/Family
Staff
WSC