Social Media Photo Release Form

Social Media Photo Release Form
Name

First NameLast Name
Birth Date

MonthDayYear
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your name preference regarding the use of your photos?
Parent or legal guardian?
What is your name preference regarding the use of your child or children's photos?
List child or children's name(s) of who social media authorization is being granted. (Please list their full name, even if you've selected differently above)
Name
Name
Name
Name
Name
Please check the boxes below, acknowledging the following:
Signature
Date Signed

MonthDayYear
Should be Empty: