photo and video release form template word

Media Consent and Release Agreement

Instructions for Use

• Fill in all bracketed information accurately, ensuring the [Subject Name] matches the government-issued identification of the individual signing the form.
• If the subject is a minor (under 18 years of age), a parent or legal guardian must sign on their behalf in the designated section.
• Retain a signed digital or physical copy of this agreement in your project files for the duration of the media usage and for a reasonable period thereafter.

Parties and Definitions

This Media Consent and Release Agreement ("Agreement") is entered into on [Date] by and between:

The Releasor (Subject): [Full Legal Name] Address: [Street Address, City, State, Zip]

The Released Party (Entity/Individual): [Company or Individual Name] Address: [Street Address, City, State, Zip]

The Media: Any photographs, video recordings, audio recordings, or other digital assets captured of the Releasor at [Location of Capture] on [Date of Capture].

Operative Clauses

1. Grant of Rights: The Releasor hereby grants the Released Party, its successors, and assigns, the irrevocable, perpetual, worldwide right and license to use, reproduce, edit, exhibit, project, display, and publish the Media in any and all media formats now known or hereafter developed, including but not limited to social media, websites, print advertising, and promotional materials.

2. Waiver of Compensation: The Releasor acknowledges that they will receive no financial compensation, royalty, or other consideration for the use of the Media, and hereby waives any right to inspect or approve the finished product or the copy that may be used in connection therewith.

3. Release and Indemnity: The Releasor hereby releases and forever discharges the Released Party from any and all claims, demands, or causes of action that the Releasor may now have or may hereafter have for libel, defamation, invasion of privacy, right of publicity, or any other claim arising out of or in connection with the use of the Media.

4. Ownership: The Releasor acknowledges that the Released Party is the sole and exclusive owner of all rights, title, and interest in and to the Media, including the copyright therein.

5. Governing Law: This Agreement shall be governed by and construed in accordance with the laws of the state of [State Name], without regard to its conflict of laws principles.

Signature and Acknowledgment

I have read this Agreement, fully understand its contents, and voluntarily agree to its terms.

Signature of Releasor: __________ Printed Name: [Full Legal Name] Date: [Date]

Parent/Guardian Consent (If Releasor is under 18): I am the parent or legal guardian of the minor named above and have the legal authority to execute this release on their behalf. Signature of Guardian: __________ Printed Name: [Guardian Full Name] Date: [Date]

Disclaimer: This document is a general framework and does not constitute formal legal advice. Laws regarding media rights and privacy vary by jurisdiction; please consult with qualified legal counsel to ensure this document meets the specific requirements of your project and location.