Audio/Video Consent and Release Form

By completing and submitting this form, I agree to give my consent to Freedom Oklahoma, its affiliates and agents, to use youth's image, audio, and/or video with regards to Youth Advocacy Month submissions for legal use in future publications, advertising, or other media activities (including the internet).

This consent includes, but is not limited to:

permission to use youth's (aforementioned above) name
permission to use quotes from film, photograph(s), tape(s), or reproduction(s) of youth, and/or recording of (but not limited to) voice, in part or in whole, in its publications, zines, or other print media, on social media and/or other electronic media (including the internet), and/or in mailings for educational purposes or awareness
permission given in perpetuity, and does not require prior approval by youth and guardian

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Parent/Guardian Contact Information

First Name Last Name

Date of Birth (Optional) Pronouns (Optional)

Gender (Optional) Sexual Orientation (Optional) Race (Optional) Ethnicity (Optional)

Street Address (Optional)

Postal Code City State/Province

Email Home Phone (Optional)

Remember me so that I can use FastAction next time.

(Optional)

Consent Form

Student's First Name

Student's Last Name

Student's Email Address

Parent/Guardian Signature (please type)