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I {insert name} hereby agree to the following terms:
1. YOUR AGREEMENT

By agreeing to this media release form, you agree to be bound by, and to comply with, these Terms and Conditions. If you do not agree to these Terms and Conditions, please do not use tick the box.

PLEASE NOTE: We reserve the right, at our sole discretion, to change, modify or otherwise alter these Terms and Conditions at any time. Unless otherwise indicated, amendments will become effective immediately. Please review these Terms and Conditions periodically.
The Media Can Be Used in the Following:
Tick all that apply
Clear Signature
Print Name

Contact Information

A media release form is a contract used to collect consent from an individual to use them on your media. This legally binding form allows a party to create, edit, take photos or videos, print or sell, or record an individual without future liability issues.

Check out the media release form below:

What’s in Our Media Release Form?

We’ve created a simple media release form but with WPForms, it’s easy to customize it to fit your business needs. To get you started, we’ve included:

    • The terms of the agreement
    • Where the media can be used
    •  E-signature, date, and print name fields
    • Client contact information section

Adapt this form to allow parents or guardians to sign the media release form on behalf of a minor. Use WPForms’ drag-and-drop form builder and ask for the individual’s age, address, and whether their full name can be used in the media.