Media Release Form
Media Release Form
Email address
I hereby authorize and consent to the use of my visual image by priyachellani.com and yourfriendlyphotographer.com, for appropriate purposes, including but not limited to: still photography, video tape, electronic and print publications, and websites. I give this consent with no claim for payment.
Signature
Name of Adult Student
Date
MM
/
DD
/
YYYY
Phone Number (in case we need to contact you)
For a child UNDER 18 years of age, I, the Parent or Guardian, hereby authorize and consent to the use of my visual image by priyachellani.com and yourfriendlyphotographer.com, for appropriate purposes, including but not limited to: still photography, video tape, electronic and print publications, and websites. I give this consent with no claim for payment.
Name of Parent/Guardian of Minor/Adult with Disability
Signature
Date
MM
/
DD
/
YYYY
Phone Number (in case we need to contact you)
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Additional Terms