This form grants permission to (Nonprofit name) to use photographs, video, and/or audio recordings taken during its Fundraiser Event.

Participant Information

Name of Participant

Parent/Guardian Name (if participant is under 18)

Contact Information

Permission Grant

I authorize and its representatives to use, reproduce, and/or publish photographs, video, and/or audio that may include my/my child’s image or voice for any lawful purpose, including but not limited to publicity, social media, and fundraising materials.

Signature of Participant

Date

Signature of Parent/Guardian

Date

Comments or Restrictions

Media Usage Permission Form

Participant Information

Permission Grant