General Photo/Video Release Form

Photo/Video Release Form

Client over the age of 18 or Legal Guardian*

First NameLast Name

I grant permission to Blue Hill Media Group LLC and its agents and employees the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of me, or members of my family, for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium. I hereby release Blue Hill Media Group LLC and its legal representatives for all claims and liability relating to said images or video. Furthermore, I grant permission to use my statements that were given during an interview or guest lecture, with or without my name, for the purpose of advertising and publicity without restriction. I waive my right to any compensation.

Phone Number*

Area CodePhone Number

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

I acknowledge that I am*

Over 18the legal guardian of the following

If legal guardian of client, please list client's name here:

Name

First NameLast Name

Signature*