IB Media Release Form

IB PHOTO/VIDEO RELEASE FORM
I hereby grant Inner Beauty Program, Inc. permission to use my childs likeness in a photograph/video without payment or any

other compensation. If the participant is under 21, there must be consent by a parent or guardian, as follows: I hereby certify that I am the
(Child's Name)
and do hereby give my consent without reservation to the foregoing on behalf of this person
(Parent/Guardian's Signature)

Clear
(Parent Name)
(Parent Email)
example@example.com
Date

MonthDay Year
Date
I am 21 years of age and am competent to contract on my own behalf. I have read this release form before signing below, and I fully understand the contents, meaning. and impact of this release.
(Signature)

Clear
Date

MonthDay Year
Date
(Print Name)
Should be Empty: