Nonprofit Youth Media Release Consent Form
Youth Information
Full Name of Youth
Date of Birth
Parent/Guardian Information
Parent/Guardian Full Name
Phone Number
Email Address
Consent
I grant permission for my child’s photograph, video, or audio recording to be used by the organization for promotional, educational, or informational purposes in print, online, and social media.
I grant permission for my child's name to be used in association with media content.
I do not give permission for media use of my child.
Signature
Parent/Guardian Signature
Date
Additional Notes