• AHR Sponsor Ticket
  • AHR Sponsorship and Table Purchase
  • Appreciative Inquiry Interviews
  • ARCO Leadership Summit 2019 Agenda
  • ARCO LS 2019 Session Detail Submission
  • ARCO Session Evaluation
  • Atlantic OHH
  • Beta Testing Feedback
  • Burlington OHH
  • C4R Check-In
  • C4R Contact
  • C4R Member Registration
  • clr
  • Communities For Recovery
  • Donate
  • F&V Contract
  • F&V Support Request
  • First Time Visit
  • Focus RWC
  • Focus RWC Activity Check-in
  • Focus RWC First Time Visit
  • Focus RWC Meeting Attendance
  • Focus RWC Member Check-in
  • Focus RWC New Member
  • Focus RWC Volunteer Log
  • Illinois Stigma
  • Internal Survey
  • Kiosk Beyond Brink
  • Kiosk Beyond Brink Form
  • Kiosk Cape Regional
  • Kiosk Cape Regional Form
  • Kiosk Courage Center
  • Kiosk Courage Form
  • Kiosk Dee’s Place
  • Kiosk Dee’s Place Form
  • Kiosk Home Template
  • Kiosk Hope Coalition
  • Kiosk Hope Coalition Form
  • Kiosk Hope Rising
  • Kiosk Hope Rising Form
  • Kiosk Never Alone
  • Kiosk Never Alone Form
  • Kiosk New Way
  • Kiosk New Way Form
  • Kiosk Recovery Beyond
  • Kiosk Recovery Beyond Form
  • Kiosk RioGrande
  • Kiosk RioGrande Form
  • Kiosk Savannah
  • Kiosk Savannah Form
  • Kiosk Set Up Information
  • Kiosk Template Form
  • Kiosk Trilogy
  • Kiosk Trilogy Form
  • Kiosk Turning Point
  • Kiosk Turning Point Form
  • Kiosk Wakeup
  • Kiosk Wakeup Form
  • LRCC
  • LRCC Activity Check-in
  • LRCC First Time Visit
  • LRCC Meeting Attendance
  • LRCC Member Check-in
  • LRCC New Member
  • LRCC Volunteer Log
  • NJ CARS Forms
  • NJ OAG Kiosk Info
  • NJ RISE OHH
  • NJ-CARS Media Consent
  • OHH Activity
  • OHH Kiosk RH
  • OLDOrg Kiosk
  • Onboarding Feedback
  • Org Kiosk Check-In
  • Org Kiosk Contact
  • Org Kiosk New Member
  • Org Name Kiosk
  • PCAC Kiosk
  • Peer Coach Academy Kiosk
  • PIK Consent
  • Prevention TRS
  • Privacy Policy
  • RCCF Form
  • RDP Agreements
  • RDP Feedback
  • RDP LITE – COVID SURVEY
  • RDP Survey
  • Recovery Connection
  • RLS/AHR Sponsorship Leads
  • SCRW Kiosk
  • Serenity House of Flint
  • SHOF Activity Check-in
  • SHOF BARC-10
  • SHOF First Time Visit
  • SHOF HH Study
  • SHOF Meeting Attendance
  • SHOF Member Check-in
  • SHOF New Member
  • SHOF Volunteer
  • Signature
  • Springs Recovery Connection
  • SRC Event/Training Attendance
  • SRC Meeting Attendance
  • SRC Member Check-in
  • SRC Member Registration
  • Sunrise Community for Recovery Wellness Kiosk
  • Tech Onobarding
  • Technical Assistance Feedback
  • Thriving U Kiosk
  • Thriving United Kiosk
  • TU Check-In
  • TU Contact Request
  • TU Participant
  • USARA
  • USARA Activity Check-in
  • USARA Meeting Attendance
  • USARA Member Check-in
  • USARA New Member
  • USARA Volunteer Log
  • Website Feedback
  • Wilkes Recovery Revolution Kiosk
  • WRR Kiosk
  • Uncategorized
Faces & Voices of Recovery Data Hub

  • YYYY dash MM dash DD
  • If current address does not exist please use NA
  • MEDIA CONSENT FORM

  • I hereby consent to participate in participant success stories during any part of my recovery process. Prevention Links is also granted editorial license to edit all corresponding content and media without the need for further permission, which this Consent Agreement hereby provides.
  • If you are an Operation Helping Hands participant: I grant Prevention Links the right to include my contact information to the Prosecutors Office, Office of the Attorney General, and affiliates to be contacted for questions regarding my story and OHH process.
  • I understand that Preventions Links is not obligated to use any of the aforementioned materials in which I, my children and/or my family may appear. In the event that Prevention Links does use any of the aforementioned, Prevention Links retains the right under the perpetual license to edit any and all related materials at any time. I hereby waive the right to inspect, review, and/or approve any use in advance of, during or following preparation, distribution and publication. I hereby unconditionally release Prevention Links any of its agents, employees, and affiliates from any and all claims, demands and liabilities whatsoever in connection with this Agreement and with any of the material published in accordance with this Agreement. By signing below, I represent that I am of legal age, have full legal capacity and am authorized to sign on behalf of myself. I agree that I may not revoke this Agreement and will not deny the existence of This Agreement in whole or in part at any time. I have read the foregoing in its entirety and fully understand its contents and its meaning.
  • Complete Forms with Signature

  • MM slash DD slash YYYY