Media Release Consent Form

A release form that records who is granting permission to use their photo or video, who is receiving that permission, and how the media will be used, with signed attestations confirming legal age or guardian consent.

Use this template

Page 1

Date

Name of Releasor

Nombre

Apellido

Phone Number

Name of Person Photographed/Filmed

Nombre

Apellido

Phone Number

The Media obtained shall be used for

Page 2

Name of Releasee

Nombre

Apellido

Email of Releasee

Phone Number of Releasee

Age of Releasee

Address of Releasee

Dirección

Ciudad

Estado / Provincia

Código postal

Page 3

Section: Attestations

Attestation of Legal Age

I attest that I am 18 years of age or older

Attestation of Parent/Guardian

I attest that I am the legal parent/guardian of the minor and give my consent

Signature of Releasor or Releasor's Guardian

Sign here

Media Release Consent Form

Page 1

Page 2

Page 3

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