Parent Consent for Nonprofit Fundraiser Media Release

Child Information

Child's Full Name Child's Age

Parent/Guardian Information

Parent/Guardian Full Name Parent/Guardian Contact Info

Organization Information

Nonprofit Organization Name Fundraiser/Event

Media Release Consent

I, as the parent/legal guardian of the above-named child, give consent to the nonprofit organization to photograph, videotape, and/or record my child and to use such media for promotional, fundraising, or informational purposes in print and digital materials including websites and social media.

Limitations or Special Instructions (if any)