Minor Video Release Form
Complete this form to provide permission for recording and using a minor’s video content. All fields are required for the release to be valid.
Minor’s Full Name
*
First Name
Last Name
Parent or Guardian’s Full Name
*
First Name
Last Name
Relationship to Minor
*
Please Select
Parent
Legal Guardian
Other
Parent or Guardian’s Email Address
*
example@example.com
Parent or Guardian’s Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Release and Permission
*
By signing below, I confirm that I am the parent or legal guardian of the minor named above and hereby grant permission for the recording and use of their video content as described.
*
Date Signed
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Release
Submit Release
Should be Empty: