Fluent Forms Template Library

Media Release Form Template

Collect media consent, personal details, and signatures securely with this structured media release form.

Media Release Form

Media Release Form Template

Media Release Form

Releasor's Details

Please put correct information of the Releasor.


Usage Declaration


About this template...

A Media Release Form is designed to collect consent and essential personal details from individuals who agree to the use of their image, voice, or content for media purposes. This template helps organizations document permission clearly while keeping the process structured and easy to complete.

Using Fluent Forms, you can organize the form with section breaks and form steps to guide users through the agreement, personal information, and consent sections without overwhelming them. Name, phone, email, address, and date fields collect participant details, while numeric fields can be used for reference numbers or age confirmation. Checkboxes and GDPR fields ensure clear consent and compliance, custom HTML blocks allow you to display legal text or instructions, and the signature add-on captures a legally valid signature for confirmation.

All submissions are stored securely in one place, making it easy to manage records, verify consent, and maintain organized documentation. This Media Release Form can be customized for events, productions, marketing campaigns, or educational use and works smoothly on any device.

Media Release Form

Features of this Template

  • Section breaks and form steps guide users through the release process clearly
  • Name, phone, and email fields collect essential participant contact information
  • Address fields capture full location details for record keeping
  • Date field records when the media release consent was given
  • Numeric field supports age confirmation or internal reference numbers
  • Checkbox and GDPR fields ensure explicit consent and compliance
  • Custom HTML blocks display release terms, instructions, or legal notices
  • Signature Add-on captures legally valid confirmation from participants
  • Mobile-responsive design allows forms to be completed on any device