Museum Exhibit Facial Consent Form
Please complete this form to provide consent for the use or display of your facial image in a museum exhibit.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Exhibit or Project Title
*
Brief Description of the Exhibit or Context
Consent for Use of Facial Image
*
I give permission for my facial image to be used or displayed in the museum exhibit as described.
I do NOT give permission for my facial image to be used or displayed.
If signing on behalf of a minor or another person, state your relationship to the participant
Signature
*
Submit Consent
Submit Consent
Should be Empty: