Minor Media Release Consent Form

This form grants permission for a minor to be photographed, videotaped, and/or recorded by the organization for nonprofit purposes.

Minor’s Information

Full Name of Minor Date of Birth Address

Parent/Guardian Information

Parent/Guardian Name Phone Number Email

Consent

I hereby grant permission for the above-named minor to be photographed, videotaped, and/or interviewed for use by the organization in its publications, website, social media, or other promotional materials, without compensation.
I do NOT grant permission for the above-named minor’s image or likeness to be used. Parent/Guardian Signature Date