Appendix B – Photo and Video Consent Form
Name of Participant (print): ___________________________________________________________________
Name of Parent/Guardian (print): ______________________________________________________________
(when the Participant is younger than the age of majority)
Date: _______________________________________
1. I, being the Participant or the parent or legal guardian of the minor Participant, hereby grant to the
Organization the permission to photograph and/or record the Participant’s image and/or voice in pictures or
videos (collectively the “Images”), and to use the Images to promote the sport and/or the Organization through
traditional media such as newsletters, websites, television, film, radio, print and/or display form, and through
social media such as Instagram, Facebook, YouTube, and Twitter. I understand that I waive any claim to
remuneration for use of audio/visual materials used for these purposes. This consent will remain in effect in
perpetuity.
2. I, being the Participant or the parent or legal guardian of the minor Participant, hereby fully release, discharge,
and agree to save harmless the Organization, from any and all claims, demands, actions, damages, losses or
costs that might arise out of the collection, use or disclosure of the Images or taking, publication, distortion of
the Images, negatives, and masters or any other likeness or representation of the Participant that may occur
or be produced in the taking of said Images or in any subsequent processing thereof, including without
limitation any claims for libel, passing off, misappropriation of personality, or invasion of privacy.
3. I, being the Participant or the parent or legal guardian of the minor Participant, UNDERSTAND AND AGREE,
that I have read and understood the terms and conditions of this document. On behalf of myself, my heirs and
assigns, I agree that I am signing this document voluntarily and to abide by such terms and conditions.
Signature of Participant: _____________________________________________
OR, if the Participant is younger than the age of majority
Signature of Parent/Guardian: _________________________________________
