testimonial release form pdf

Media Consent and Testimonial Release Agreement

Instructions for Use

• Fill in all bracketed information accurately, ensuring the Releasor’s legal name matches their government-issued identification.
• Select the appropriate checkboxes regarding compensation and usage rights to reflect the actual agreement between the parties.
• Ensure both parties sign and date the document; provide a fully executed copy to the Releasor for their records.

Parties & Definitions

This Agreement is entered into on this [] day of [], 20[__], by and between:

Releasor: [Full Legal Name of Individual/Entity], residing at [Full Address] ("Releasor").

Company: [Company Name], located at [Company Address] ("Company").

Operative Clauses

1. Grant of Rights: Releasor hereby grants to Company, its successors, and assigns, the irrevocable, perpetual, worldwide, royalty-free right and license to use, reproduce, publish, distribute, and display the testimonial, statements, name, image, likeness, and voice of the Releasor (collectively, the "Materials") in any media now known or hereafter developed, including but not limited to social media, websites, marketing collateral, and broadcast materials.

2. Compensation: Releasor acknowledges that: [ ] No compensation, payment, or royalty is provided in exchange for this release. [ ] Compensation in the amount of [__________] has been provided to the Releasor, the receipt of which is hereby acknowledged.

3. Editing and Derivative Works: Company shall have the right to edit, modify, crop, or create derivative works from the Materials at its sole discretion, provided that such edits do not materially alter the original intent of the testimonial in a defamatory manner.

4. Waiver of Review: Releasor waives any right to inspect or approve the finished product or the copy that may be used in connection therewith, or the use to which it may be applied.

5. Representations: Releasor represents that they are at least 18 years of age (or have obtained legal guardian consent) and have the full right and authority to enter into this agreement. Releasor warrants that the testimonial provided is true and accurate to the best of their knowledge and does not infringe upon the intellectual property or privacy rights of any third party.

6. Release and Indemnity: Releasor hereby releases and discharges Company, its officers, employees, and agents from any and all claims, demands, or causes of action arising out of or in connection with the use of the Materials, including but not limited to claims for defamation, libel, or invasion of privacy.

7. Governing Law: This agreement shall be governed by the laws of the State/Province of [__________].

Signature & Acknowledgment

By signing below, Releasor acknowledges they have read this document, understand its terms, and voluntarily agree to be bound by them.

Releasor Signature: __________ Printed Name: [] Title (if applicable): [] Date: [__________]

Company Representative Signature: __________ Printed Name: [] Title: [] Date: [__________]

Legal Disclaimer: This document is a general framework and does not constitute formal legal advice. Laws regarding publicity rights and releases vary by jurisdiction. Consult with qualified legal counsel to ensure this document meets your specific business needs and local compliance requirements.