Photo, Social Media & Advertising Release

Open or download the original PDF

Complete your information

Fields marked * are required. Your entries stay on this page until you submit; they are not saved automatically.

Full legal name *

Date of birth *

Phone number *

Email address *

3. Photo & media consent *I agreeI do not agree

4. Advertising & promotional use *I agreeI do not agree

5. Compensation & release *I agreeI do not agree

Review and sign

Your signature applies to the original form and the completed response record.

You may decline any of the photo permissions. Signing records your choices and does not change a declined selection.

I have reviewed the complete form and my answers. I intend my typed name below to be my electronic signature on this document. I agree to receive this signed record electronically and can download and save a PDF copy. My answers are accurate to the best of my knowledge. For informed consent, I also confirm the risks have been explained and my questions have been answered.

Electronic signature — type your full name *

The signing date and time are recorded automatically. Contact Melissa if you prefer paper forms.