Consent and Release Form for Interviewing, Photographing and Videotaping (United States)

A release form that lets an organization interview, photograph, or record a participant on video, with separate signature sections for adults, minors with a guardian, and teens aged 13 to 17.

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Organization Name

Purpose of Interview/Photo/Video

Section: Adult Participant (18 and Older)

Name of Individual

Signature of Individual

Sign here

Email of Individual

Date

Section: Minor Participant (Under 13, with Parent/Guardian)

Name of Minor

Name of Parent/Guardian

Signature of Parent/Guardian

Sign here

Email of Parent/Guardian

Date

Section: Minor Participant (Ages 13 to 17)

Name of Individual between ages 13-17

Signature of Individual

Sign here

Address of Individual

Phone of Individual

Email of Individual

Date

Consent and Release Form for Interviewing, Photographing and Videotaping (United States)

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