Testimonial Consent and Release
This release protects a producer of media content, and should be
obtained from any person from whom the producer is obtaining
their name, recording, or photograph. This release ensures that a
producer is not subject to future liability and is able to proceed
with distributing the content.
ALL INFORMATION AND FORMS ARE PROVIDED “AS IS” WITHOUT ANY WARRANTY,
EXPRESS, IMPLIED, OR OTHERWISE, INCLUDING AS TO THEIR LEGAL EFFECT AND
COMPLETENESS. They are for guidance and should be modified to meet your needs and the
laws of your state. Use at your own risk. Docstoc and anyone who participated in providing or
modifying any form is not creating or entering into an Attorney-Client relationship. Docstoc
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does not provide legal advice. The information and forms are not a substitute for the advice of
your own attorney.
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 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 worldwide.
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.
Date: ______________________
______________________________ ______________________________
Releaser Producer
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 Testimonial Consent and Release to the fullest extent permitted by law.
Parent/Guardian’s Signature Relationship to Participant
_______________________________________________________________________________
Parent/Guardian’s Name (Printed) Address and Telephone Number
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Testimonial Consent and Release
Check List
The check list is provided to inform you about the document in question and assist you in its
preparation.
1. The Testimonial Consent and 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.
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