Sample Patron Release

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I understand that this is an educational sample, not legal, tax, financial, safety, medical, licensing, regulatory, or other professional advice. I accept the Terms of Use, Professional Disclaimers, and applicable Tool warnings. I will obtain professional review before real-world use.

Step 1

Fill out the form

Type directly into the boxes and check any items that apply.

SAMPLE — for illustration only. Have an attorney review and tailor to your situation and current Texas law before use.

Photo & Video Release

In exchange for good and valuable consideration, the receipt of which I acknowledge, I grant __________________ (the “Creator”) and the Creator’s assigns the irrevocable permission to photograph and record me, and to use, reproduce, edit, publish, and distribute my likeness, voice, name, and image in any and all media now known or later developed — including social media, websites, and promotional materials — without further compensation, notice, or approval. I confirm that I am at least 18 years old, that I have read and understood this release, and that I release the Creator from any and all claims arising from the permitted use.

Participant

Printed name

Signature

Date

Contact (optional)

If the Participant Is Under 18 — Parent or Guardian Must Sign

Minor’s printed name

Parent / guardian printed name

Parent / guardian signature

Relationship to minor · Date

Creator / Business

Creator or business name

Using the Release

Get it before or right after filming — not weeks later when the person is gone.

Keep signed releases on file — a clear photo or scan of the signed form is fine to store.

For minors, the parent or guardian signs — never the minor, and never skip it.

For low-stakes, non-monetized clips, a clear written ’yes’ in text or DM can be a lightweight substitute — but use the real form for anything prominent, paid, or branded.

When in doubt, get the signature — it’s far cheaper than a dispute later.

Sample Only — Not Legal Advice

This appendix, including the release form, is a general educational sample only. It is not legal advice and is not a substitute for a release drafted or reviewed by a licensed attorney for your specific circumstances.

Right-of-publicity, consent, and privacy law — including rules for minors — vary and change. Before relying on any release, have a licensed Texas attorney review and adapt it. Never feature a minor without confirmed parent or guardian consent.

Additional notes

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Read the complete source and context.

This working version preserves the source’s terminology and structure while making it easier to complete. Read the original appendix and related chapters before relying on the tool.

Read Appendix C · Filming-Consent Essentials + Sample Patron Release Open Volume 4

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