FREE TEMPLATE · 2026 EDITION

Media & Video Release Form Template

Set precise permission for recording and using a person’s image, voice, interview, or performance with channels, duration, compensation, and restrictions.

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Document details

Set the date, jurisdiction, and your internal reference. * Required for completion.

Document date*

US state*

County

Document reference

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2026

Media & Video Release Form

The participant gives permission for the specifically identified recordings and approved uses below, subject to the stated limits. Image, audio, video, paid promotion, and synthetic-use choices must be read separately.

This document is prepared on [Document date] for the matter identified as [Document reference], with [US state] and [County] recorded as the relevant state and county. Confirm the actual jurisdictions and recipient requirements before relying on the completed document.

1. People & organizations

The first named person or organization is [Participant legal name], whose address is [Participant address] and whose contact details are [Participant email] and [Participant phone]. The second named person or organization is [Producer or organization legal name], whose address is [Producer or organization address] and whose contact details are [Producer or organization email] and [Producer or organization phone].

2. Material & intended uses

The participant’s permission concerns the project [Project or campaign] and the following specifically identified material: [Specific photographs or recordings covered]. Permission is limited to the approved purpose [Approved purpose], through [Approved channels and placements], within [Approved territory], for [Permission duration and end date].

Permitted editing and context are [Permitted editing and context], and prohibited uses or alterations are [Prohibited context, claims, or editing]. Do not treat general publication permission as consent to an unapproved synthetic or training use.

3. Compensation, minors & withdrawal

The compensation arrangement is [Compensation or no compensation], and the credit or anonymity preference is [Credit or anonymity preference].

A participant’s likeness permission does not itself convey a photographer’s copyright.

4. Scoped likeness permission

Subject to the stated restrictions, the participant grants the organization permission to use the identified likeness, image, voice, or recording for the described purpose, channels, territory, and duration. No permission is granted outside that scope.

5. Separate rights and synthetic use

Copyright and third-party permissions remain separate. This release does not authorize synthetic impersonation, voice cloning, or AI training; any such proposal requires a separate explicit agreement.

6. Withdrawal process

A withdrawal request must be handled under the agreed prospective-use terms and applicable law. Explain the practical treatment of prior distribution and avoid promising removal from every third-party copy.

Attach the actual referenced records and resolve conflicting instructions before use.

These entries identify the intended signing arrangements; they do not verify authority or replace an actual signature, required acknowledgment, or recipient form.

Signatures

Participant Signature: __________________________________

Printed name: [First signer printed name] · Title: [First signer title] · Date: [Signing date]

Organization representative Signature: __________________________________

Printed name: [Second signer printed name] · Title: [Second signer title] · Date: [Signing date]

Guardian — where required Signature: __________________________________ Printed name: ________________________________ Date: ______________

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MAKE THE DOCUMENT WORK FOR YOUR SITUATION

About this media & video release form

Set precise permission for recording and using a person’s image, voice, interview, or performance with channels, duration, compensation, and restrictions. This editable template brings the key details into one document: material & intended uses, compensation, minors & withdrawal. Complete it online, compare the live preview with your records, and download a blank or completed PDF or editable Word document.

What the template includes

The online builder and downloaded documents use the same fields. A selected state can add relevant research prompts. Complete only applicable items; add explanations for exceptions rather than assuming a blank entry resolves them.

Document details4 inputs +

Set the date, jurisdiction, and your internal reference.

Document date *
US state *
County
Document reference

People & organizations8 inputs +

Use legal names and current contact information.

Participant legal name *
Participant address *
Participant email
Participant phone
Producer or organization legal name *
Producer or organization address *
Producer or organization email
Producer or organization phone

Material & intended uses13 inputs +

Separate the person’s permission from copyright ownership in the work.

Project or campaign *
Capture date
Capture location
Specific photographs or recordings covered *
Covered material
Approved purpose *
Approved channels and placements *
Approved territory *
Permission duration and end date *
Paid advertising permission
Permitted editing and context *
Prohibited context, claims, or editing *
AI training, synthetic likeness, or voice cloning

Compensation, minors & withdrawal11 inputs +

Set expectations the organization can actually honor.

Compensation or no compensation *
Credit or anonymity preference
Any participant review or approval step
Prospective withdrawal contact and conditions
Treatment of already distributed material
Participant under legal adult age?
Guardian full name and authority basis
Child assent or participation notes
Photographer or creator copyright permission reference
Sensitive setting or confidentiality restrictions
Material storage and access arrangements

Additional details & signing7 inputs +

Add attachments, exceptions, and the names of authorized signers.

Attachments / supporting records
Exceptions / additional terms
First signer printed name
First signer title
Second signer printed name
Second signer title
Signing date

How to complete it

1. Document details
Set the date, jurisdiction, and your internal reference. Review document date, us state, county, document reference against your source records.
2. People & organizations
Use legal names and current contact information. Review participant legal name, participant address, participant email, participant phone and the remaining details against your source records.
3. Material & intended uses
Separate the person’s permission from copyright ownership in the work. Review project or campaign, capture date, capture location, specific photographs or recordings covered and the remaining details against your source records.
4. Compensation, minors & withdrawal
Set expectations the organization can actually honor. Review compensation or no compensation, credit or anonymity preference, any participant review or approval step, prospective withdrawal contact and conditions and the remaining details against your source records.
5. Additional details & signing
Add attachments, exceptions, and the names of authorized signers. Review attachments / supporting records, exceptions / additional terms, first signer printed name, first signer title and the remaining details against your source records.

Practical tips

A participant release does not transfer the photographer’s copyright.
Obtain renewed permission if the purpose changes substantially.

Before signing or submitting

Likeness, privacy, publicity, minor consent, and contract rules vary by state. This scoped draft needs review for sensitive, commercial, or minor-related uses.