I, the undersigned, hereby grant permission for the use of photographs, video, or other media images of the minor listed below, to be used without compensation, for any purpose in connection with activities or promotions related to:

Organization/Project Name:

Minor's Information

Minor's Name:

Date of Birth:

Parent/Guardian Information

Parent/Guardian Name:

Relationship to Minor:

Contact Information:

Consent & Authorization

I understand that these images may be used in print, online publications, presentations, websites, and social media. I understand that no royalty, fee, or other compensation shall become payable to me or the minor by reason of such use.

Specific Limitations (if any):

Parent/Guardian Signature: Date:

Minor Photo Release Consent Form

Minor's Information

Parent/Guardian Information

Consent & Authorization