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Consent Release
Video, Photo, and Audio Consent
I give my consent to the reproduction of my image, or property I own, by means of digital or magnetic audio/video recording, or still motion photography to Wichita Tech Services, LLC, Wichita Tech Services, LLC’s customers, advertisers, and assigns (collectively “Users”). I consent to the use of my image in any medium including copyrighted works for any lawful purpose including advertising without inspection or approval by me. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I further grant Users the right to use my name, biography, or other material I voluntarily provide in connection with any such uses of the photographs, video, and sound recordings. I grant Users the right to copy, edit, alter, and otherwise change the photographs, video, and sound recordings at User discretion. I hereby release any and all claims against any User utilizing this material. This consent shall be a continuing consent with no limitations or reservations, except those stated herein.
Date
(Required)
MM slash DD slash YYYY
Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
Address
(Required)
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
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Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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Montana
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New York
North Carolina
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Northern Mariana Islands
Ohio
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Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Signature
Minor Child
If the above-named individual is a minor child, the below signed parent or legal guardian of the above-named minor child hereby consents to and gives permission to the above on behalf of such minor child.
Name (Parent or Legal Guardian)
First
Last
Signature
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