TX HHS Form 5403. Media Release – Authorization to Photograph and Record a Volunteer or Service Recipient

The TX HHS Form 5403, "Media Release – Authorization to Photograph and Record a Volunteer or Service Recipient," is used to obtain permission from individuals to photograph and record them for the purposes of program development, education, and promotion. This form helps solve the problem of obtaining consent from participants in public events or programs.

This authorization grants Texas Health and Human Services (HHS) permission to publish and publicly exhibit photographs, audio, and video recordings in any lawful and legitimate manner. The form also outlines the rights and responsibilities of both the individual granting permission and HHS. Key features include the required contact information and signature of the service recipient, as well as the option to revoke authorization at any time.

This form should be used when photographing or recording individuals who participate in public events or programs sponsored by HHS. It is essential to understand that revoking this authorization does not necessarily mean that previously created materials will be removed from use. The form number and full title, TX HHS Form 5403, "Media Release – Authorization to Photograph and Record a Volunteer or Service Recipient," should be used when submitting the form.