This is a document that allows a producer to use the releaser’s name, recording,
photographs or testimonials. The releaser grants the producer perpetual consent to use
their name or likeliness in promotional materials. This document ensures that the
producer will not be subject to future liability and is able to proceed with distributing the
content. If the releaser is younger than eighteen (18) years of age, their parents or
guardians must sign this document on their behalf. This document should be used by
small businesses or other entities that want to obtain the consent of an individual to use
their name in testimonials or photographs.
Testimonial Consent and Release
I, ______________________ [insert name] (“Releaser”) residing at __________________
[insert address], hereby consent to give and forever grant to ______________________ [insert
name] (“Producer”) located at __________________ [insert address], its representatives,
licensees, marketers, subsidiaries and all other related parties or publishers of its promotional
materials and their successors and assigns, the right of use of any text or other materials,
prepared or created by Producer, which text or other material depicts, Releaser’s name,
recording, photographs or testimonials attributed to Releaser still, single, multiple or moving in
which I may be included in whole or in part, or composite. This Testimonial Consent and
Release (“Release”) is given for good and valuable consideration, the receipt and sufficiency of
which I hereby acknowledge. My consent includes the right to use my name, recordings,
photographs or testimonials attributed to Releaser in any documents or products it uses
Releaser also hereby releases all parties involved with or using such a copy of my name,
recordings, photographs or testimonials from any claim by me for compensation. I understand
the rights that I am giving up, and I am satisfied with the terms of this Release.
If the Releaser is less than eighteen (18) years of age, complete the following the parent or legal
guardian must complete the following part of the Release.
This is to certify that I as parent/guardian with legal responsibility for Releaser, do consent and
agree not only to his/her release, but also for myself, and my heirs, assigns and next of kin to release
and indemnify the Producer from any and all liability arising from my/our minor child's
involvement in granting the above Release to the fullest extent permitted by law.
Parent/Guardian’s Signature Relationship to Participant
Parent/Guardian’s Name (Printed)
© Copyright 2013 Docstoc Inc. registered document proprietary, copy not 2
Testimonial Consent and Release
The check list is provided to inform you about the document in question and assist you in its
1. The Release form should be used only to obtain consent for the use of a quotation in an
advertisement, publication, or on product literature.
2. If the quotation to be used comes from a minor (generally under 18 years of age), be sure the
parent or legal guardian also signs to acknowledge consent.
3. The Producer should keep the original signed Release. A photocopy should be given to the
person giving the consent for his or her records. If a minor is involved, give one copy to the
minor and another separately to the parent or legal guardian.
© Copyright 2013 Docstoc Inc. registered document proprietary, copy not 3
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and no general information or forms or like the kind Docstoc provides can always correctly fit every circumstance.
Note: Carefully read and follow the Instructions and Comments contained in this document for your customization to suit your specific
circumstances and requirements. You will want to delete the Instructions and Comments from open bracket (“[“) to close bracket (“]”)
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laws of your state. The Instructions and C