Photo/Video Consent Release Form
AUTHORIZATION TO USE PHOTOGRAPHS AND/OR AUDIO-VISUAL
I, _______________________________________________________, hereby authorize professional performing artist and award-winning storyteller, J’miah Nabawi, to use, reproduce, and/or publish photographs and/or video that may pertain to me— including my likeness and/or voice in a professional manner without compensation. I understand that the photo images and voice/video sound-bites and images and related written material may be used in various publications; public affairs releases; on his web sites and on television and radio as public service advertising (PSA) and broadcasts to promote his work as an acclaimed performing artist and for activities that may promote increased awareness about the importance of and support for teaching artists and artists-in-education programming and educational materials that may compliment and enrich educational programs and academic content; National and State Performance Standards; Core Curriculum; and civic endeavors for positive impressions within our communities.
This authorization is continuous and may only be withdrawn by my written and verbally documented request to cancel this authorization.
Description of Material (Photos/Audio-Visual): Video and still photography, Voice-over sound-bites from personal interviews related to the activities and events as described above.
Signature (Adult, 18 years of age and older)
Name of Minor under 18 years of age _________________________________________
Parent’s Signature for the above named Minor ______________________________________________________
©Consent Release, Performing Artist, J’miah Nabawi • P.O. Box 13946 • Savannah, GA 31416