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Student Media Release Form Template

Ensure Your Students' Media Rights are Protected

Securing permission to use students' images and names can be a hassle without the right tools. This Student Media Release Form Template helps educators and school administrators easily obtain consent for print or digital publications from students and their parents. With this template, you can streamline communication about media usage, ensure legal protection, and maintain trust with families, all while staying compliant with media regulations. Experience less stress in your media planning and boost your school's outreach efforts with this straightforward solution.

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Student full name
Student date of birth
Student ID (optional)
School or organization name
Grade or class (optional)
Is the student under 18 years of age?
Yes
No
If other, specify relationship (optional)
Consenting party full name
Email address
Phone number
Your role regarding the student
Self (student, age 18+)
Parent/Legal guardian
Other
Please Specify:
Project or event description
Date of media capture
Location(s) of media capture
Photographer/videographer name or company (optional)
I grant permission to capture and use the student's
Photographs
Video recordings
Audio recordings
First name
Full name
Student work samples
Permitted uses (select all that apply)
School/organization website
Official social media channels
Printed materials (brochures, posters)
Press releases and media outreach
Presentations and events
Internal training and communications
Third-party partners promoting the program
Local news outlets
Time period for this release
Ongoing until revoked in writing
For this specific project/event only
Until the following date (enter below)
If applicable, end date for this release
Authorization for editing, adaptation, and composite use that does not distort meaning
Yes
No
Additional restrictions or notes (optional)
Name usage preference
No name usage
First name only
Full name allowed
Participation is voluntary and no compensation is provided
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
I may revoke consent at any time by written notice to the organization
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
I am the parent/legal guardian or adult student authorized to grant this release
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Signature of parent/guardian or adult student
Date signed
Initials (optional)
{"name":"Student full name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Student full name, Student date of birth, Student ID (optional)","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Paper art illustration representing a student media release form template design for educational use.

When to use this form

Use this form when you capture photos, video, or audio of students for your website, social channels, yearbook, broadcasts, or the school newspaper. It is essential for classes, clubs, sports, theater, concerts, field trips, and campus events. You get clear permission to record and publish, define where and how long you may use the content, and document any limits a family requests. It protects your school and your partners, and it speeds up approvals when media is time-sensitive. For students performing on stage or camera, pair it with a Talent release form. If you plan to publish student writing or artwork, also review the Author's release form.

Must Ask Student Media Release Questions

  1. What is the student's full name, school or program, and the activity being documented?

    This ties the consent to the right person and context, so you can match releases to media files later. Including the class, team, or event reduces follow-up and speeds approval.

  2. If the student is under 18, does a parent or guardian consent, and what is their name and relationship?

    Minors cannot legally consent in many regions, so this confirms that a responsible adult authorizes use. The relationship field helps your team verify the signer if questions arise.

  3. Which types of media may you capture and where can you use them (photo, video, audio; website, social, print, press)?

    Listing channels and media types prevents disputes and sets clear expectations. For auditions or featured roles, pair this consent with a Casting call release form to cover performance-specific terms.

  4. Are there any limits or opt-outs, such as no names, no tags, group-only images, or no live streams?

    Capturing opt-outs up front avoids editing delays and honors family preferences. Common limits include no names in captions, no individual portraits, or no live streaming.

  5. How long does consent last, and how can the student or parent revoke it?

    Stating a time frame and revocation process clarifies how to handle future requests. Include where to send written revocations and what happens to existing materials after withdrawal.

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