Sample Photo / Video Release Form

I hereby grant (Company Name) permission to use my likeness in a photograph/video, without payment or any other compensation.

If the participant is under 21, there must be consent by a parent or guardian, as follows: I hereby certify that I am the parent/guardian of (Child's Name), and do hereby give my consent without reservation to the foregoing on behalf of this person (Child's Name).

___________________________________ ________________________
(Parent/Guardian’s Signature)                                      (Date)

I am 21 years of age and am competent to contract on my own behalf. I have read this release form before signing below, and I fully understand the contents, meaning, and impact of this release.

____________________________________ ________________________
(Signature)                                                                (Date)


(Print Name)

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