Open Options Photo Release Form

Client's Name

Birth Date

Address

City, State, Zip

Email

Phone

 I hereby authorize Open Options at 3100 Broadway, Suite #330, Kansas City, Missouri 64111, to disclose to general public through the Open Options website, annual appeal, social media, newsletter, or news release my name and use of my image. I also understand that I may revoke this consent at any time by contacting Open Options at 816-983-2204 or info@openoptionskc.org.

Electronic signature (please enter your full name):