Video Consent Form

Video Consent Form
Name
First NameLast Name
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Nature of Video
Purpose of use of video
Video File Upload
Cancelof
I hereby declare that I am the original owner of the video and I represent and warrant that:
I grant the use, distribution, display, and reproduction of the video royalty-free and authority to use the video and all words words and phrases mentioned therein for {purposeOf} purposes.
I grant to the distribution of the images and the video including the subjects, in print, electronic, including video formats capable for viewing through electronic devices.
I hereby waive my right to inspect and/or approve the video for which it may be applied.
I release, discharge, and hold harmless the recipient of the video against any and all claims that I may have arising from or in connection with my participation in the said video.
Date
MonthDayYear
Date
Signature
Clear
Should be Empty: