MiSS MEDIA RELEASE AGREEMENT

MEDIA RELEASE AGREEMENT
Participant:*
Age:*
Phone:*
Format: (000) 000-0000.
I hereby grant to The Mosaic Film Experience and its partners the right to use, publish, and distribute my name, likeness, voice, and any recordings of my participation in the MI School Stories initiative and all associated activities.
PERMITTED USES:
Content Creation: Photographs, video recordings, audio recordings, on-camera interviews, behind-the-scenes documentation, event footage, and finished content.

Distribution: Educational and promotional materials, website content, social media platforms (Instagram, Facebook, TikTok, YouTube, LinkedIn, Twitter, etc.), streaming platforms, television broadcasts, digital distribution, community presentations, grant applications, academic research, conference presentations, and news media coverage (print, digital, broadcast).

Future Use: Content may be used in perpetuity for ongoing promotional and educational purposes related to the MI School Stories initiative and similar programs.
My participation and agreement to this release is completely voluntaryI understand this program involves filming, photography, and audio recording for documentary productionI have read and understand all terms and scope of media usage rights I am grantingI am 18+ years old, OR a parent/guardian will also sign below
Participant Signature:*
Date:*

MonthDayYear
Date
Print Name:*
FOR PARTICIPANTS UNDER 18 - PARENT/GUARDIAN CONSENT REQUIRED
Parent/Guardian Name:
Relationship:
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Parent/Guardian Signature:
Date:

MonthDayYear
Date
Should be Empty:

MEDIA RELEASE AGREEMENT

PERMITTED USES:

FOR PARTICIPANTS UNDER 18 - PARENT/GUARDIAN CONSENT REQUIRED