{"id":1139,"date":"2023-05-02T08:59:13","date_gmt":"2023-05-02T12:59:13","guid":{"rendered":"https:\/\/research.ohioguidestone.org\/study\/?page_id=1139"},"modified":"2023-05-02T10:45:22","modified_gmt":"2023-05-02T14:45:22","slug":"media-release-forms","status":"publish","type":"page","link":"https:\/\/research.ohioguidestone.org\/study\/about-us\/media-release-forms\/","title":{"rendered":"Media Release Forms"},"content":{"rendered":"<p>Thank you for participating with us.<\/p>\n<p>Please sign the media release form below to give us final permission to use your picture or video.<\/p>\n<p>If you have any questions, please contact our Research Team at 440-260-8865 or research@ohioguidestone.org.<\/p>\n<div class=\"wpforms-container wpforms-container-full wpforms-container-save-resume\" id=\"wpforms-728\"><form id=\"wpforms-form-728\" class=\"wpforms-validate wpforms-form\" data-formid=\"728\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/study\/wp-json\/wp\/v2\/pages\/1139\" data-token=\"c547c1070d9bcc24e93b6d4a6b0897b4\" data-token-time=\"1776652052\"><div class=\"wpforms-head-container\"><div class=\"wpforms-title\">OhioGuidestone Media Release<\/div><\/div><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-728-field_17-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"17\"><label class=\"wpforms-field-label\">Electronic Agreement <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-728-field_17\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-728-field_17_1\" name=\"wpforms[fields][17][]\" value=\"By checking this box, I agree to use electronic records and electronic signatures.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-728-field_17_1\">By checking this box, I agree to use electronic records and electronic signatures.<\/label><\/li><\/ul><\/div><div id=\"wpforms-728-field_25-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"25\"><div id=\"wpforms-728-field_25\"><img decoding=\"async\" src=\"https:\/\/research.ohioguidestone.org\/study\/wp-content\/uploads\/2021\/06\/OGSLogo_PMS_NewTagline_Black.jpg\" style=\"float:right;width:200px;height:149px;\"\/><\/div><\/div><div id=\"wpforms-728-field_23-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-first\" data-field-id=\"23\"><label class=\"wpforms-field-label\">Name (&quot;Releasor&quot;) <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-728-field_23\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][23][first]\" required><label for=\"wpforms-728-field_23\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-728-field_23-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][23][last]\" required><label for=\"wpforms-728-field_23-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-728-field_24-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half\" data-field-id=\"24\"><label class=\"wpforms-field-label\">Date of Birth <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-large\"><select name=\"wpforms[fields][24][date][m]\" id=\"wpforms-728-field_24-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][24][date][d]\" id=\"wpforms-728-field_24-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][24][date][y]\" id=\"wpforms-728-field_24-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/div><div id=\"wpforms-728-field_12-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"12\"><div id=\"wpforms-728-field_12\"><p>I, on my own behalf and, if applicable, on behalf of the minor child named above (\u201cReleasor\u201d), consent to OhioGuidestone and its subsidiary organizations, including A Renewed Mind (collectively the \u201cAgency\u201d), using Releasor\u2019s name, likeness, voice, interview, and personal information, including protected health information and substance use disorder information (\u201cInformation\u201d) on the terms described below. The Information may be contained in, without limitation, photographs, interviews (with myself or others), anecdotes (from myself or others), and other recordings (\u201cMedia\u201d). The Agency may use the Media in promotional and other public materials to support the work of the Agency.<\/p> \r\n<br \/>\r\n<p>You consent to and authorize the use of any and all Media that the Agency has regarding Releasor, and of any reproductions of the Media, for any purpose whatsoever, in any medium whatsoever, including, but not limited to, advertising fliers, pamphlets, websites, videos, e-mails, social media, blogs, publications, billboards, posters, signs, and magazines. You also consent to the use of Releasor\u2019s name in connection with the Media. You agree that the Media may also be used without identifying Releasor as its subject, at the Agency\u2019s discretion. You understand that information used or disclosed according to this Media Release may be subject to re-disclosure by the recipient and may no longer be protected.<\/p> \r\n<br \/>\r\n<p>You agree that the Media, including any negatives and digital copies, shall be the sole property of the Agency, with full right of disposition in any manner whatsoever. The Agency will have the right, among other things, to edit the Media and compile it with other text, graphics, and photographs to create promotional and other materials. You hereby waive any right to inspect or approve the finished product or any written copy that may be used in connection with the Media.<\/p>\r\n<br \/>\r\n<p>You, on your own behalf and, if applicable, on behalf of the minor child named above, release and discharge the Agency and its agents, representatives, and assignees from any claim or cause of action now known or later discovered for, without limitation, invasion of privacy, right of publicity, and defamation arising out of the use, exploitation, and publication of the Media.<\/p><\/div><\/div><div id=\"wpforms-728-field_18-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"18\"><div id=\"wpforms-728-field_18\"><h3>Dated Signatures<\/h3>\r\n<\/div><\/div><div id=\"wpforms-728-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><label class=\"wpforms-field-label\">Adult Releasor Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-728-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" required><label for=\"wpforms-728-field_0\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-728-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" required><label for=\"wpforms-728-field_0-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-728-field_19-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-728-field_19\">Releasor Signature <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-728-field_19\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][19]\" autocomplete=\"off\" inputmode=\"none\" required><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-728-field_19-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Clear Signature<\/div>\n\t\t\t<\/div><\/div><div class=\"wpforms-field-description\">This electronic signature holds the same force and effect as an in-person signature.<\/div><\/div><div id=\"wpforms-728-field_20-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-728-field_20\">Date <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-728-field_20\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-large\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][20][date]\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-728-field_21-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"21\"><label class=\"wpforms-field-label\">Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-728-field_21\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][21][address1]\" required><label for=\"wpforms-728-field_21\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-728-field_21-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][21][address2]\" ><label for=\"wpforms-728-field_21-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-728-field_21-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][21][city]\" required><label for=\"wpforms-728-field_21-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-728-field_21-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][21][state]\" required><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-728-field_21-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-728-field_21-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][21][postal]\" required><label for=\"wpforms-728-field_21-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/div><div id=\"wpforms-728-field_11-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"11\"><label class=\"wpforms-field-label\">Child Releasor Name<\/label><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-728-field_11\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][11][first]\" ><label for=\"wpforms-728-field_11\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-728-field_11-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][11][last]\" ><label for=\"wpforms-728-field_11-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-728-field_22-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"22\"><label class=\"wpforms-field-label\">Name of Parent\/Guardian<\/label><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-728-field_22\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][22][first]\" ><label for=\"wpforms-728-field_22\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-728-field_22-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][22][last]\" ><label for=\"wpforms-728-field_22-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-728-field_5-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-728-field_5\">Signature of Parent\/Guardian<\/label><input type=\"text\" id=\"wpforms-728-field_5\" class=\"wpforms-signature-input wpforms-screen-reader-element\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][5]\" autocomplete=\"off\" inputmode=\"none\" ><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-728-field_5-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Clear Signature<\/div>\n\t\t\t<\/div><\/div><div class=\"wpforms-field-description\">This electronic signature holds the same force and effect as an in-person signature.<\/div><\/div><div id=\"wpforms-728-field_4-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-728-field_4\">Date <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-728-field_4\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-large\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][4][date]\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-728-field-hp\" class=\"wpforms-field-label\">Email<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-728-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"728\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/pages\/1139\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-728\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><\/div><\/form><\/div>  <!-- .wpforms-container -->\n","protected":false},"excerpt":{"rendered":"<p>Thank you for participating with us. Please sign the media release form below to give us final permission to use your picture or video. 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