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Media Release · Popular

Student Athlete Photo & Video Media Release Form

Capture parental and guardian consent for student athlete photos and videos used in school promotions, events, and athletic programs.

Use This Template Free Preview

Frost theme

formbuilder.ai/f/student-athlete-photo-video-media-release-consent-form

Student Athlete Photo & Video Media Release Consent Form

Student Athlete Full Name

· · ·

Date of Birth

· · ·

Age

· · ·

Submit

The Student Athlete Photo & Video Media Release Consent Form is designed to help schools, athletic departments, and sports programs obtain proper authorization to capture and publish images, videos, and other media featuring student athletes. It covers essential details including the student's name, grade, sport, and team, along with clearly defined consent terms for specific media types, distribution channels, and duration of use.

This form is ideal for high school and collegiate athletic programs, school communications teams, and sports coordinators who need a legally sound, organized way to document media permissions. The built-in parent or guardian consent section ensures compliance when the student athlete is under 18, making it a comprehensive solution for protecting both students and institutions.

By using this template, you eliminate ambiguity around media usage rights, give families transparency and control over how their student's likeness is used, and streamline your consent collection process. Customize it to reflect your school's branding, specific media channels, and any unique restrictions your program requires.

3 Pages

21 Questions

~7min To complete

Free No credit card needed

Field types Short Text ×4 Full Name ×2 Date ×2 Email ×2 Multiple Choice ×2 Single Choice ×2 Yes / No ×2 number Long Text Phone termsandconditions Signature

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Student Athlete Information 8 questions

Student Athlete Information

1 Student Athlete Full Name * Full Name

2 Date of Birth * Date

3 Age * number

4 Grade Level * Short Text

5 Sport(s) * Short Text

6 Team / Program Name * Short Text

7 Student ID Number Short Text

8 Student Email Address Email

Page 2 Media Release Details 6 questions

Media Release Authorization

By signing this form, you grant permission for the school, athletic department, and its authorized representatives to capture, use, and publish photographs, video recordings, and other media of the student athlete named above. These materials may be used for promotional, educational, and informational purposes including but not limited to the channels selected below.

1 Authorized Media Types * Multiple Choice

2 Approved Usage & Distribution Channels * Multiple Choice

3 Duration of Consent * Single Choice

Restrictions & Limitations

4 Are there any specific restrictions on how the student athlete's image or likeness may be used? * Yes / No

5 If yes, please describe any restrictions or limitations Long Text

6 Do you consent to the student athlete's full name being used alongside their image or video? * Yes / No

Page 3 Parent/Guardian Consent & Signature 7 questions

Parent / Legal Guardian Consent

If the student athlete is under 18 years of age, a parent or legal guardian must complete this section. By signing below, you acknowledge that you have read and understand the terms of this media release and voluntarily consent to the use of the student athlete's image, likeness, and voice as described.

1 Parent / Legal Guardian Full Name * Full Name

2 Relationship to Student Athlete * Single Choice

3 Contact Phone Number * Phone

4 Contact Email Address * Email

5 I have read and understand this media release consent form. I voluntarily agree to the terms outlined above and grant permission for the capture, use, and distribution of the student athlete's image, likeness, and voice for the purposes and channels specified. I understand that I may revoke this consent at any time by submitting a written request to the athletic department. * termsandconditions

6 Signature of Parent / Legal Guardian (or Student Athlete if 18+) * Signature

7 Date Signed * Date

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.