{"id":14755,"date":"2019-11-09T23:42:47","date_gmt":"2019-11-09T23:42:47","guid":{"rendered":"https:\/\/bhssc.org\/?page_id=14755"},"modified":"2025-11-13T16:13:38","modified_gmt":"2025-11-13T16:13:38","slug":"mediarelease","status":"publish","type":"page","link":"https:\/\/bhssc.org\/mediarelease\/","title":{"rendered":"Media Release"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"14755\" class=\"elementor elementor-14755\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-6851f8a elementor-section-full_width elementor-section-stretched elementor-section-height-default elementor-section-height-default\" data-id=\"6851f8a\" 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<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-f145788\" data-id=\"f145788\" 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<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-inner-section elementor-element elementor-element-db12daa elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"db12daa\" 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-inner-column elementor-element elementor-element-87e4482\" data-id=\"87e4482\" 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-4560d1b elementor-widget elementor-widget-heading\" data-id=\"4560d1b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">MEDIA RELEASE CONSENT FORM<\/h2>\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\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-8f67087 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"8f67087\" 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-c597001\" data-id=\"c597001\" 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-da7ebd4 elementor-widget elementor-widget-text-editor\" data-id=\"da7ebd4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h6>This form is used by all five divisions of Black Hills Special Services Cooperative (BHSSC) to collect media release consent. Whether you are participating in a program, training, or event through any BHSSC division, this form ensures we have your permission to use media responsibly.<\/h6>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1c98918 eael-gravity-form-button-custom elementor-widget elementor-widget-eael-gravity-form\" data-id=\"1c98918\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"eael-gravity-form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"eael-contact-form eael-gravity-form eael-contact-form-align-default\">\n\t\t        <script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_unknown gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_4' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_4'  action='\/wp-json\/wp\/v2\/pages\/14755' data-formid='4' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_4_15\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_15'>Date Submitted<\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_4_15' type='text' value='03\/10\/2026' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_3\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Your Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_4_3'>\n                            \n                            <span id='input_4_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_4_3_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_3_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_4_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_4_3_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_3_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_4_13\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Media Release Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_13'>\n\t\t\t<li class='gchoice gchoice_4_13_0'>\n\t\t\t\t<input name='input_13' type='radio' value='Consenting for Yourself'  id='choice_4_13_0'    \/>\n\t\t\t\t<label for='choice_4_13_0' id='label_4_13_0' class='gform-field-label gform-field-label--type-inline'>Consenting for Yourself<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_13_1'>\n\t\t\t\t<input name='input_13' type='radio' value='Parent\/Guardian Consenting for Child (under 18) or Adult'  id='choice_4_13_1'    \/>\n\t\t\t\t<label for='choice_4_13_1' id='label_4_13_1' class='gform-field-label gform-field-label--type-inline'>Parent\/Guardian Consenting for Child (under 18) or Adult<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_13_2'>\n\t\t\t\t<input name='input_13' type='radio' value='Both'  id='choice_4_13_2'    \/>\n\t\t\t\t<label for='choice_4_13_2' id='label_4_13_2' class='gform-field-label gform-field-label--type-inline'>Both<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_13_3'>\n\t\t\t\t<input name='input_13' type='radio' value='For Staff-Uploading Media Release Manually'  id='choice_4_13_3'    \/>\n\t\t\t\t<label for='choice_4_13_3' id='label_4_13_3' class='gform-field-label gform-field-label--type-inline'>For Staff-Uploading Media Release Manually<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_1\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Media Release Adult Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_1.1' id='input_4_1_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_4_1\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_4_1_1' >I Consent & Agree to the Following<\/label><input type='hidden' name='input_1.2' value='I Consent &amp; Agree to the Following' class='gform_hidden' \/><input type='hidden' name='input_1.3' value='9' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_4_1' tabindex='0'>I hereby grant to BHSSC \u2013 Black Hills Special Services Cooperative (hereafter referred to as BHSSC) permission and consent to publish my name and photograph (and by video photography) my image for use in BHSSC\u2019s videos, printed publications, websites, and social media, and to freely use such images in the exhibition, advertising, editorial use and publicizing thereof as BHSSC, its assigns, successors and licensees may elect. I acknowledge that since my participation in videos, print publications, websites, and social media produced by BHSSC is voluntary, I will receive no financial compensation. I further agree that my participation in any videos, print publications, websites, and social media produced by BHSSC confers upon me no rights of ownership whatsoever. I also release BHSSC, its contractors, and its employees from any and all liability for any claims by me or any third party in connection with my participation.<br \/>\n<\/div><\/li><li id=\"field_4_12\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Media Release Parental\/Guardian Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_12.1' id='input_4_12_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_4_12\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_4_12_1' >I Consent & Agree to the Following<\/label><input type='hidden' name='input_12.2' value='I Consent &amp; Agree to the Following' class='gform_hidden' \/><input type='hidden' name='input_12.3' value='9' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_4_12' tabindex='0'>I hereby grant to BHSSC \u2013 Black Hills Special Services Cooperative (hereafter referred to as BHSSC) permission and consent to publish my child's\/participant's name (listed in this agreement) and photograph (and by video photography) my child's\/participant's image for use in BHSSC\u2019s videos, printed publications, websites, and social media, and to freely use such images in the exhibition, advertising, editorial use and publicizing thereof as BHSSC, its assigns, successors and licensees may elect. I acknowledge that since my participation in videos, print publications, websites, and social media produced by BHSSC is voluntary, I or my child\/participant will receive no financial compensation. I further agree that my child's\/participant's participation in any videos, print publications, websites, and social media produced by BHSSC confers upon me or my child\/participant no rights of ownership whatsoever. I also release BHSSC, its contractors, and its employees from any and all liability for any claims by me, my child\/participant, or any third party in connection with my child's\/participant's participation.<br \/>\n<\/div><\/li><li id=\"field_4_10\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_10'>Child&#039;s\/Ward&#039;s Name Consenting for<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_10'>Enter your child's name. Separate by commas if you are consenting for one or more. Required for children under 18.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_10' id='input_4_10' class='textarea medium'  aria-describedby=\"gfield_description_4_10\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_4_5\" class=\"gfield gfield--type-phone gfield--input-type-phone gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_5'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_4_5' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_4\" class=\"gfield gfield--type-email gfield--input-type-email gf_right_half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_4'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_4' id='input_4_4' type='email' value='' class='medium'     aria-invalid=\"false\" aria-describedby=\"gfield_description_4_4\" \/>\n                        <\/div><div class='gfield_description' id='gfield_description_4_4'>a copy of your Media Release form will be sent to you. <\/div><\/li><li id=\"field_4_16\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_16'>Your Initials (e-signature)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_4_16' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_6\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_6'>Signature (e-signature)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><input type='hidden' value='' name='input_6' id='input_4_6_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_4_6_Container' class='gfield_signature_container ginput_container' style='height:180px; width:500px; ' ><canvas id='input_4_6' width='500' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/bhssc.org\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_4_6_toolbar' style='margin:5px 0;position:relative;height:20px;width:500px;max-width:100%;'><img id = 'input_4_6_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_4_6_data' name='input_4_6_data' value=''><\/div><\/li><li id=\"field_4_18\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_18'>File<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='16777216' \/><input name='input_18' id='input_4_18' type='file' class='large' aria-describedby=\"gfield_upload_rules_4_18\" onchange='javascript:gformValidateFileSize( this, 16777216 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_4_18'>Max. file size: 16 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_4_18'><\/div> <\/div><\/li><li id=\"field_4_17\" class=\"gfield gfield--type-useyourdrive gfield--input-type-useyourdrive gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_17'>Upload Media Release Forms<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_17'>Media release forms can be uploaded as images via your phone or mobile devices (take a photo) or as pdf's. Depending on file size and network speed files may take some time to upload. 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Whether you are participating in a program, training, or event through any BHSSC division, this form ensures we have your permission to use media responsibly. 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