Life Rights Consent Form
Life Rights Consent Form — provide your details and review the consent before signing.
Your name
*
First Name
Last Name
Email address
*
example@example.com
Phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Production or project title
*
Describe the life story or experiences covered by this consent
*
Media or formats covered
*
Film or television
Digital or online media
Print or publication
Promotional materials
Other
Territory for use
*
Please Select
Worldwide
United States
Other territory, as agreed in writing
Duration of permission
*
Please Select
Perpetual
10 years
5 years
Other duration, as agreed in writing
Life Rights Consent Form — I voluntarily authorize the project identified above to use and portray the life experiences I have described, including my name, likeness, voice, and biographical details, in the media and territory selected for the stated duration. I understand that the project may edit or adapt this material, and that this consent does not guarantee any particular portrayal or inclusion. I confirm that I have had the opportunity to review this consent and ask questions before signing.
Signature confirming consent
*
Submit Consent
Submit Consent
Should be Empty: