MEDIA RELEASE CONSENT FORM

MEDIA RELEASE AND CONSENT FORM

Participant Information

Full Name: __________________________________________________
Phone Number: _______________________________________________
Email Address: _______________________________________________
Address: _____________________________________________________

Grant of Rights

For valuable consideration received, I hereby grant [Insert Newspaper/Media Outlet Name] (“Publisher”) and its legal representatives, successors, and assigns, the irrevocable and unrestricted right to:

Interview, record, photograph, and video record me.
Use, publish, edit, display, and distribute my name, quote, image, likeness, voice, and biographical information in print, digital, social media, online archives, and all future promotional or editorial platforms.

Permissions & Releases

Ownership: I acknowledge that all photographs, recordings, and text created by the Publisher are the sole property of the Publisher.
Inspection: I waive any right to inspect or approve the finished product, including written copy, video footage, or printed materials, before publication.
Compensation: I understand that I will receive no financial compensation, royalties, or additional consideration now or in the future for the use of these materials.
Liability: I hereby release and hold harmless the Publisher, its employees, and agents from any claims, demands, or liabilities arising out of or in connection with the publication of these materials, including claims for defamation or invasion of privacy.

Signatures

For Adult Participants (Age 18+):

I have read this release, fully understand its contents, and freely consent to its terms.

Signature: ___________________________________ Date: _________________

For Minor Participants (Under Age 18):

I am the parent or legal guardian of the minor named below. I have read this consent form and give full permission for their participation under the terms stated above.

Minor’s Full Name: ___________________________________________
Parent/Guardian Name: _______________________________________
Parent/Guardian Signature: ____________________________________
Date: _________________