Consent Form Template Interview

MEDIA INTERVIEW, RECORDING, AND LIKENESS CONSENT AND RELEASE AGREEMENT

Document Control:

• Effective Date: [Effective Date, e.g., November 1, 2023]
• Version: 2.1 (Corporate Production Standard)
• Jurisdiction / Governing Law: [State/Country, e.g., State of New York]

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1. OFFICIAL NOTICE & LEGAL DISCLAIMER

This legal instrument governs the capture, processing, and commercial or institutional exploitation of personal likeness, voice, and biographical data. Execution of this document establishes a binding legal release. Participants are advised to review all terms thoroughly prior to signing. This template is designed for enterprise compliance and must be reviewed by qualified legal counsel prior to deployment in specific operational jurisdictions.

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2. PARTIES & DEFINITIONS

For valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties identified below enter into this Media Interview, Recording, and Likeness Consent and Release Agreement ("Agreement") as of the date executed below:

• "Company" (Media Producer / Data Controller): [Full Legal Corporate Name], with its principal place of business located at [Company Address] ("Company").
• "Participant" (Data Subject / Interviewee): [Full Legal Name of Participant], residing at [Participant Residential Address] ("Participant").
• "Project": [Title or Description of Project, e.g., Q4 Executive Leadership Podcast / Corporate Training Video Series] ("Project").

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3. OPERATIVE CLAUSES & TERMS

1. Grant of Rights

Participant hereby irrevocably grants to Company, its successors, assigns, licensees, and legal representatives, the absolute, worldwide, perpetual, royalty-free, and transferable right and license to record, film, photograph, capture, digitize, and otherwise reproduce Participant’s voice, name, image, likeness, performance, biographical details, and statements (collectively, "Likeness") in connection with the Project, across any and all media formats now known or hereafter devised (including, without limitation, audio, video, digital streaming, print, and interactive media).

2. Ownership of Materials

Participant acknowledges and agrees that all physical and digital recordings, transcripts, outtakes, photographs, and derivative works captured, derived, or created by Company in connection with the Project (collectively, the "Materials") shall be the sole and exclusive property of Company. Company shall possess all rights of copyright, trademark, and proprietary interest in and to the Materials, with the unrestricted right to use, publish, exhibit, broadcast, edit, modify, license, or sell the Materials in whole or in part, in any manner Company deems appropriate.

3. Waiver of Inspection and Approval

Participant hereby waives any right to inspect or approve the finished product, the advertising copy, promotional materials, or the editorial context in which Participant’s Likeness may be utilized. Company is under no obligation to use, broadcast, or distribute the Materials, or exercise any of the rights granted herein.

4. Release and Discharge of Liability

Participant, on behalf of themselves, their heirs, executors, administrators, and assigns, hereby knowingly, voluntarily, and unconditionally releases, discharges, and holds harmless Company, its parent entities, subsidiaries, affiliates, officers, directors, employees, agents, licensees, and successors (collectively, the "Released Parties") from any and all claims, demands, liabilities, damages, costs, expenses, and causes of action of any kind whatsoever—whether known or unknown, foreseen or unforeseen—arising out of or in connection with the use of the Materials or Likeness, including without limitation any claims for defamation, invasion of privacy, right of publicity, copyright infringement, or economic loss.

5. Representation and Warranty

Participant represents and warrants that:

• (a) They are of legal age and possess the full legal capacity to execute this Agreement;
• (b) If executing on behalf of a minor, Participant is the legal parent or guardian with full authority to grant these rights;
• (c) The statements made and information provided by Participant during the interview are true, accurate, and do not infringe upon, misappropriate, or violate the intellectual property, privacy, or contractual rights of any third party.

6. Governing Law and Dispute Resolution

This Agreement shall be governed by, construed, and enforced in accordance with the internal laws of the jurisdiction specified in the Document Control section above, without regard to its conflict of law principles. Any legal action or proceeding arising under this Agreement shall be brought exclusively in the state or federal courts located within [County, State], and Participant hereby consents to the personal jurisdiction of such courts.

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4. SIGNATURES & ACKNOWLEDGMENT BLOCK

IN WITNESS WHEREOF, the parties hereto have executed this Media Interview, Recording, and Likeness Consent and Release Agreement as of the date first written below.

PARTICIPANT (OR LEGAL GUARDIAN)

Signature: ____________________________________________________

Printed Name: [Full Legal Name of Participant]

Title (if applicable): [Title, e.g., Subject Matter Expert]

Date: [Month, Day, Year]

COMPANY REPRESENTATIVE

Signature: ____________________________________________________

Printed Name: [Full Legal Name of Corporate Signatory]

Title: [Corporate Title, e.g., Executive Producer / Director of Communications]

Date: [Month, Day, Year]

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5. STEP-BY-STEP EXECUTION GUIDE

• Prior to Interview Capture: Ensure all bracketed fields in the Document Control and Parties sections are completed accurately before the interview commences. Do not record any audio or video until this document has been reviewed and executed.
• Execution Verification: Confirm that the Participant (or their legally authorized parent/guardian, if the participant is a minor) has hand-signed or digitally signed the Acknowledgment Block with a timestamp matching or preceding the recording start time.
• Metadata & Secure Archiving: Store the executed agreement in a centralized corporate compliance repository paired digitally with the raw media files, transcripts, and session logs to maintain an unbroken audit trail for intellectual property validation.
• Cross-Border Deployment: If the production involves international participants or broadcasting into distinct regulatory zones (such as the EU under GDPR), ensure supplementary data privacy addendums covering Personal Data Processing are executed alongside this release.