Media Opt-Out Form – Adult 19+ Media Opt-Out Form - Adult 19+ This form is to be used for any participants, volunteers or individuals who are 19 years of age or older at the time of consent and signature. Date(Required) MM slash DD slash YYYY Name(Required) First Last Phone(Required)Email(Required) Media Opt-Out(Required) I consentto Big Brothers Big Sisters of Victoria Capital Region (BBBSV) producing video, images, audio and/or written quotes including myself. Please do NOT produce, record or share any type of media including me due to confidentiality, safety, privacy or other concerns.
