fbpx
Doctor Filling Form

Included below are two examples of media release forms, one for adults and one for children. Any lawyer does not approve these, nor are we lawyers, but we’ve had many churches request something like this, so it’s a TEMPLATE to get reviewed by a lawyer. It would help if you had it reviewed by a lawyer because local and state laws differ.

Adult Media Release

I hereby grant the following rights and permissions to ________________(organization name), his/her heirs, legal representatives, and assigns those for whom the company is acting, and those acting with his/her authority and permission. They have the irrevocable, perpetual, and unrestricted right and permission to take, use, re-use, publish, and republish photographs, videos, and audio of me or in which I may be included, in whole or in part, or composite or distorted in character or form, without restriction as to changes or alterations, in conjunction with my own or a fictitious name, or reproductions thereof in color or otherwise, made through any medium at his/her studios or elsewhere, and in any media now or hereafter known, specifically including but not limited to print media and distribution over the internet for illustration, promotion, art, editorial, advertising, trade, or any other purpose whatsoever. I specifically consent to the digital compositing or distortion of the photographs, videos, and audio, including without restriction any changes or alterations as to color, size, shape, perspective, context, foreground, or background. I also consent to the use of any published matter in conjunction with such photographs. I hereby waive any right that I may have to inspect or approve the finished product or products and the advertising copy or other matter that may use in connection with them or the use to which they may be applied. I hereby release, discharge, and agree to hold harmless ________________(organization name), his/her heirs, legal representatives, and assigns. All persons acting under his/her permission or authority or those for whom he/she is acting, from any liability by any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of such photographs, videos, and audio or any subsequent processing of them, as well as any publication of them, including without limitation any claims for libel or violation of any right of publicity or privacy. I hereby warrant that I am of full age and have the right to contract in my own name. I have read the above authorization, release, and agreement before its execution, and I am fully familiar with this document’s contents. This document shall be binding upon me and my heirs, legal representatives, and assigns.

Then include a place to gather printed name(s), date, and signature(s).

Minor Release Form

I hereby grant the following rights and permissions to ________________(organization name), his/her heirs, legal representatives, and assigns those for whom the company is acting, and those acting with his/her authority and permission. They have the irrevocable, perpetual, and unrestricted right and permission to take, use, re-use, publish, and republish photographs, videos, and audio of the minor or in which the minor may be included, in whole or in part, or composite or distorted in character or form, without restriction as to changes or alterations, in conjunction with my own or a fictitious name, or reproductions thereof in color or otherwise, made through any medium at his/her studios or elsewhere, and in any media now or hereafter known, specifically including but not limited to print media and distribution over the internet for illustration, promotion, art, editorial, advertising, trade, or any other purpose whatsoever. I specifically consent to the digital compositing or distortion of the photographs, videos, and audio, including without restriction any changes or alterations as to color, size, shape, perspective, context, foreground, or background. I also consent to the use of any published matter in conjunction with such photographs. I hereby waive any right that I or the minor may have to inspect or approve the finished product or products and the advertising copy or other matter that may be used in connection with them or the use to which they may be applied. I hereby release, discharge, and agree to hold harmless ________________(organization name), his/her heirs, legal representatives, and assigns. All persons acting under his/her permission or authority or those for whom he/she is acting, from any liability by any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of such photographs, videos, and audio or any subsequent processing of them, as well as any publication of them, including without limitation any claims for libel or violation of any right of publicity or privacy. I hereby warrant that I am a legally competent adult and a parent or legally appointed guardian of the minor. I have every right to contract for the minor in the above regard. I state further that I have read the above authorization, release, and agreement before its execution and that I am fully familiar with the contents of it. This release shall bind the minor and me and our respective heirs, legal representatives, and assigns.

Then include a place to gather printed name(s), date, and signature(s) from their legal guardian.

Who Wrote this?

Subscribe To Our Newsletter

Get updates and learn from the best

More To Explore

Pssstttttt—Want to know our secrets?

Here’s how to learn more from church leaders across the world: 

  1. Stay up-to-date on the people, technologies, trends, and best practices shaping the future of communication strategies for your church, delivered directly to your inbox. >> Join the List
  2. Join 20,000+ peer communicators worldwide who are part of the Church Communications® community, supporting each other each and every day >> Join the Facebook Group
  3. Explore related topics in more depth on the Church Communications® Podcast >> Subscribe to the Podcast
  4. Connect with us on social >> Instagram, Facebook Page, Twitter
 

Disclosure of Material Connection: Some of the links in the post above are “affiliate links.” This means if you click on the link and purchase the item, we will receive an affiliate commission. Regardless, we only recommend products or services we use personally and believe will add value to my readers. We are disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”