Musician Performance Media Consent Form
Grant permission for the recording, use, and distribution of your musical performance.
Full Name of Musician
*
First Name
Last Name
Stage Name (if applicable)
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Event Name or Performance Title
*
Event Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Event Location
*
Types of Media Consent Granted
*
Photography
Audio Recording
Video Recording
Live Streaming
Use in Promotional Materials
Are there any restrictions or conditions on media use?
Signature of Musician (or Parent/Guardian if under 18)
*
Date Signed
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Consent
Submit Consent
Should be Empty: