Photo/video Consent And General Release Form printable pdf download

Photo/video Consent And General Release Form

Photo/Video Consent and General Release Form

I hereby authorize the American Cancer Society to use pictures of me (or my child/ward) taken in a

photograph, digital image, videotape, motion picture, and/or testimonial (written words). The

undersigned hereby releases the American Cancer Society, its agents or employees, as well as any

and all users and exhibitors of said pictures, from any and all claims, demands, accountings, and

causes for which the aforesaid videotape, testimonial, motion picture, digital image, or photograph

likeness may be used pursuant to this Consent and General Release. It is also my understanding that I

will receive no compensation for my likeness or testimonial.

Signature:

_______________________________________ Date: __________________

Printed Name:_______________________________________

Name of person(s) in photo, if different: _______________________________________

Address

_______________________________________

Phone(s):

_______________________________________

Email:

_______________________________________

Witness

Signature:

_______________________________________ Date: __________________

Printed Name: _______________________________________

Photo/video Consent And General Release Form