Media Release Consent Form

For Nonprofit Organization

I hereby grant permission to the nonprofit organization named below to use photographs, video, audio recordings, or written accounts of me for publicity, promotion, news, and web content, including but not limited to printed and digital publications, social media, and other media.

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Nonprofit Organization Name Participant Name

Address

City

State

ZIP Code

Phone Email Description of Photo/Video/Interview (if applicable) Signature Date

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Parent/Guardian Name (if participant is under 18) Parent/Guardian Signature Date