Consent of media release
Wild Oak Haven
Name of releasor
First Name
Last Name
Phone
-
Area Code
Phone Number
Email
example@example.com
Birth Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
I give permission for the following children to be photographed and/or recorded on video. I understand that these images or recordings may be used by Wild Oak Haven in print, online, and social media platforms. (Please include child's name, age and your relationship to the minor)
(Child's name, age, your relationship to the minor)
The Media obtained shall be used for
Marketing, flyer, and brochures
Yes
Video Use
Yes
Social media/websites
Yes
Confirm
I, (hereinafter referred to as "Releasor"), grants permission to Wild Oak Haven (hereinafter referred to as"Releasee"), to use my media (photograph image and/or video footage and/or audio recordings).I likewise understand that I may be identifiable from the reproduction of the media by the Releaseeindicated herein this agreement.I hereby waive my rights to inspect or approve the media for production that may be used by the Releaseefor purposes stated herein, from hereon forward.I likewise waive any right to royalties or any compensation arising from or related to the use of the image.
I certify that I am of legal age and competent to contractin my own name. I have read this release before signingbelow and I fully understand the contents, terms, and the effect of this release.
I am the parent or legal guardian of the named minor in this agreement. I have read this release before signing below, and I fully understand the contents, terms, and the effect of this release.
Signature of Releasor or Releasor's Guardian
Signed Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: