Video Release Agreement

Voluntary Video Release Agreement

For release of IP-CCTV camera footage to pertinent police departments.
Agreement Terms: In the event that any video recording is voluntarily released to a police department, a "Video Release Agreement" must be completed. This agreement is with the police department representative that actually receives the video recording and is in addition to any evidence receipt that the police department may furnish. The owner/operator may discuss with legal counsel before voluntarily releasing a video recording. A copy of this agreement will be retained once completed.
Owner/Operator agrees to release a video recording from McDonald's Store #*
Located At:*
Requested video date/time, and area of restaurant:*
This will help to narrow footage to the involved incident, or list if multiple cameras/events are needed.
Video footage will be released to the listed police department without formal court process, subject to the following condition(s):

1. Police Department agrees that it will use the video for law enforcement purposes only and that no video will be released to the media without prior notification to McDonald's.

By signing below, I am agreeing to the above terms on behalf of the listed police department, and I represent that I have authority to bind the listed police department to the terms of this agreement.
Police Department*
Please do not use acronyms or initials (ie CPD).
Date*

MonthDayYear
Authorized Police Representative Email*
Email of representative to recieve the footage, or link to download footage.
Print Name - Authorized Representative of Police Department*
Signature - Authorized Representative of Police Department*

Clear
Should be Empty:

Voluntary Video Release Agreement