Media Consent Form

{{company_name}}

{{company_address}}

Phone: {{phone}} | Email: {{email}} | Web: {{website}}

Media Consent Form

Media Consent Form

Subject of Consent

I, {{full_name}}, residing at {{address}}, hereby grant {{company_name}} (hereinafter referred to as "the Company"), located at {{company_address}}, permission to use my image, voice, and/or likeness in photographs, video recordings, audio recordings, or any other media (hereinafter referred to as "Media").

Purpose of Use

The Media may be used for the following purposes:

• Promotional and marketing materials, including brochures, advertisements, and digital campaigns.

• Internal communications and training.

• Public relations and media outreach.

• Educational and informational content.

• Social media platforms controlled by the Company.

Scope of Consent

I understand and agree that the Company may use the Media without compensation, perpetually, and throughout the world. The Company may edit, alter, copy, exhibit, publish, or distribute the Media for any of the aforementioned purposes.

I waive any right to inspect or approve the finished product wherein my likeness appears. I also waive any right to royalties or other compensation arising or related to the use of the Media.

Release of Liability

I hereby release, discharge, and agree to hold harmless the Company, its officers, directors, employees, and agents from any and all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

Revocation of Consent

I understand that I may revoke this consent at any time by providing written notice to {{company_name}} at {{company_email_address}}. Upon receipt of such notice, the Company will make reasonable efforts to cease future use of the Media, however, I acknowledge that Media already published or distributed may remain in circulation.

Declaration and Signature

I have read and understood the terms of this Media Consent Form. I voluntarily and without coercion agree to its terms.