Consent & waiver, classic form
Media release template
Consent to record and share a personal story, with what may be recorded, how the person is named, where it is used and a review option.
8 questions, 8 required, as a classic form
Use this template opens a copy in the form builder after you sign in. Adapt it with AI opens the generator with this template chosen, so you can describe your business and get the questions rewritten for it.
Every question
Your name (required)
Full name
Email or phone for the review copy (required)
Short answer
What may be recorded? Tick all you agree to. (required)
Multiple choice: Written notes and quotes, Audio recording, Video recording, Photographs of me, Photographs of my hands or back only
How should you be named? (required)
Single choice: My full name, My first name only, Anonymously, with no name and no identifying detail
Where may the story be used? (required)
Multiple choice: Our website and newsletter, Social media posts, The annual report, Grant applications to funders, News media we share the story with
Do you want to review the story before it is published? (required)
Single choice: Yes, send it to me first, No, I trust the team to use it as agreed
Signature (required)
Signature
Date (required)
Date
What you fill in
- [Your company]