Download PHOTO VIDEO CONSENT FORM Current

ATHELITE NATION, LLC.
Adult / Parental Video Consent Form
(Adult Client or Child Client’s) Name: ______________________________
Date: ______________
Background:
In an effort to promote our Company, THE ATHELITE NATION LLC will produce both video
and World Wide Web Internet publications for viewing by the general public. In addition, THE
ATHELITE NATION LLC may also use the written news media as a means to showcase the
services.
Before a child may be photographed, he/she must have parental consent. By signing below, you
are authorizing THE ATHELITE NATION LLC to include your image and name (if you are a
client) or your child’s image and name (if they are a client) in either a newspaper article, video, a
television broadcast, or a World Wide Web publication. Note: Every adult or child who returns a
consent form is not guaranteed inclusion in the publications. However, no adult or child will be
considered without written consent or parental consent.
Adult Client Signature:
______________________________
Print Name: _____________________________
Signature of Parent or Legal Guardian if Client is under the age of 18:
_____________________________________
Print Name: _____________________________