Minor Image Consent Form
Minor’s Information
Full Name of Minor
Date of Birth
Parent/Guardian Information
Full Name of Parent/Guardian
Relationship to Minor
Consent
I give permission for images/videos of the minor named above to be used for the described purposes.
I do NOT give permission for images/videos of the minor named above to be used.
Purpose for Use (e.g., publication, website, promotional materials):
Parent/Guardian Signature
Minor Signature (if appropriate)
Date