Media Participation Waiver Form
Please complete this form to give your consent for media participation, including photography, video, and audio recording.
Participant Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Event or Project Name
*
Relationship to Participant (if applicable)
*
Please Select
Self
Parent/Guardian
Legal Representative
Other
Signature of Participant or Legal Guardian
*
Date of Consent
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Waiver
Submit Waiver
Should be Empty: