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Video Consent Form

Video Consent Form

Updated July 31, 2023

A video consent form is written permission given by an individual to an entity/organization for the use of their name, image, and/or interview statements for publication. This consent comes without compensation, regardless of the amount of revenue the content generates. Once the document is signed, the entity/organization is not obligated to ask for the individual’s approval when using their name/image in any publication, advertising or other media enterprises (including the internet). A parent or guardian must sign the consent form if the individual is a minor.

How to Write

Step 1 – Download in PDF, Microsoft Word, or Open Document Text.

Step 2 – The name of the entity/organization must be entered in the first blank field near the top of the consent form.

Step 3 – The person giving their consent must initial next to each applicable permission statement, as shown in the image below.

Step 4 – Lastly, the individual must print their name, sign the form, enter their address, and include the current date.

Step 5 – If the individual is a minor, their parent or legal guardian must sign and print their name. If the form had to be read to the parent or guardian, the signature (and date) of the representative of the organization must be included at the bottom of the form.

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