Media Consent Form

Media Consent Form

Please review and sign to give consent for media use and storage.
Activity/Event
Location
Date

MonthDayYear
Date
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Consent and Acknowledgement Agreement

I acknowledge and agree that I may be photographed, filmed, or recorded (photo/video/audio) during the above activity/event. I grant permission for my name, image, voice, and/or likeness to be used, published, reproduced, stored, retained, and disclosed in promotional materials across all listed media channels, including local and cloud storage, in perpetuity, without payment, royalty, or other consideration. I understand and consent to the collection, storage, handling, accessing, managing, transferring, using, and disclosing of my personal information (including name, details, and image) for these purposes. I acknowledge that copyright in all recordings will be owned by the project/organization. I confirm that my participation and consent are given in good faith, with non-defamatory intent, and that a representative has explained this agreement to me. I provide this consent freely and with full understanding.
Signature
Print Name
Date

MonthDayYear
Date
Are you under 18 years of age?
Parent/Guardian Signature (if under 18 years old)
Parent/Guardian Print Name
Parent/Guardian Date

MonthDayYear
Date
Privacy Notice: Your personal information is collected and managed in accordance with privacy laws. It will be used only for the purposes described in this consent form and may be stored locally or on secure cloud services. You may request access to, or correction of, your information by contacting communications@reefcatchments.com.
Should be Empty: