A template that you can use to create a media release form for your project. This template provides sample text and can be adapted for use based on the context of your project and participant needs. You may wish to communicate the content verbally or in another form that works best for your participants.
It can be helpful to use a template as a starting point in order to customize your own media release form.
Media release form template
Use this template as a starting point to create a media release form for your project.
Media Release Form
☐ I hereby give permission for [Full Name] to participate in [Activity Title] as part of the [Project Name].
I hereby give permission for images of [Full Name], captured during regular and special [Project Name] activities through video and digital camera, to be used solely for the purposes of [Project Name]:
☐ educational workshops
☐ promotional material and publications
☐ [Project Name] Websites
☐ [Project Name] Social Media
and waive any rights of compensation or ownership thereto.
Name of Person (please print):
Name of Parent/Guardian (please print):
Parent/Guardian’s Signature (signing confirms all parents/guardians agree):