Media Release Form
  • About the Release Form
    • Who is Releasor?
    • Who is Release Receiver?
    • General Information
  • Complete the Document
    • Format & Signatures

Who is Releasor?

  • Indicate the releasor's full name:

    !

    A releasor is an individual who gives permission for their image, voice, likeness, story, or other personal attributes to be used by someone else in media, advertising, educational, or other forms of content.

  • Indicate the Releasor's full residential address:

  • The Releasor's age is:

  • As the Releasor is under the age of 18, provide the full name of the parent or legal guardian who signs this release on the his/her behalf:

  • Indicate the full residential address of a parent or legal guardian:

Who is Release Receiver?

  • The release receiver, a person who gets permission to use the media content, is:

  • Indicate the full name of Release Receiver:

  • Indicate the full name of a company (Release Receiver):

  • Indicate the full business or residential address of Release Receiver:

General Information

  • Select the date on which the Releasor signs this form:

  • Which state laws shall apply towards this Media Release Form?

  • Describe the media that is being released, including its medium, date of creation, content:

  • This Media Release Form shall remain in force:

  • Select the date on which this Media Release Form shall expire:

  • Describe in detail the event(s) or condition(s) that will cause this Model Release Form to expire:

  • Do you want to add a Releasor's signature?

  • Add a Releasor's signature:

Select a document's format:

PDF
DOCX
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