Nonprofit Organization Media Consent Form
Please review and complete this form to indicate your media consent preferences for our nonprofit organization’s communications and promotional materials.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Consent to Photo Capture and Use
*
I give permission for my photo to be captured and used.
I do NOT give permission for my photo to be captured or used.
Consent to Video Capture and Use
*
I give permission for my video to be captured and used.
I do NOT give permission for my video to be captured or used.
Consent to Audio Recording and Use
*
I give permission for my audio to be recorded and used.
I do NOT give permission for my audio to be recorded or used.
Preferred Name for Credits (if any)
If under 18, Parent/Guardian Name
Consent Statement
*
Signature
*
Submit Consent
Submit Consent
Should be Empty: