ATHLETE MEDIA CONSENT FORM
This consent form will remain active on the athlete’s file until superseded by the most
recent signed form.
I, ___________________________________, hereby agree and give consent for the
Body Composition of NC LLC (hereinafter referred to as Body Composition) and/or
partners to record, film, photograph, audiotape or videotape my name, image, and
performance (herein collectively referred to as “Recordings”). I hereby consent to
the use of Recordings for advertising, promotional or commercial purposes of any kind
at the sole discretion of Body Composition including, but not limited to, the Body
Composition website, brochures, blogs, all social media platforms—including, but not
limited to Facebook, Twitter, Instagram, Snap Chat, YouTube, and/or for
broadcasting on television or radio as determined by Body Composition. I understand
that the Recordings may appear in electronic form on the Internet or in other
publications outside of Body Composition’s control.
I agree that I will not hold Body Composition responsible for any harm that may arise
from such unauthorized reproduction. I hereby waive any right to approve the use of
this content now or in the future, whether the use is known to me or unknown, and I
waive any right to any royalties related to the use of this content. I hereby release
Body Composition, its officers, employees, agents and its advertising and promotional
agencies from any and all claims, demands, damages, actions, causes of action
whatsoever which I, my heirs, executors, administrators may now or hereafter have
against them or any part of them in respect to relating to the use of the Recordings,
including but not limited to libel and invasion of privacy. I understand that this
release is irrevocable by me so that Body Composition may proceed in full reliance
thereon.
I hereby consent under the Freedom of Information and Protection of Privacy Act
(USA) to the collection, use and disclosure of my images and name in relation to the
Recordings. By signing this form, I give this consent and release voluntarily on behalf
of the individual named and I understand and agree to be bound by its contents.
Please initial the paragraph below which is applicable to your present situation:
_____ – I am 18 years of age or older and I am competent to contract in my own
name. I have read this release before signing below, and I fully understand the
contents, meaning and impact of this consent form. I understand that I am free to
address any specific questions regarding this form by submitting those questions in
writing prior to signing, and I agree that my failure to do so will be interpreted as a
free and knowledgeable acceptance of the terms of this consent form.
_____ – I am the parent or legal guardian of the below named child. I have read this
release before signing below, and I fully understand the contents, meaning and
impact of this consent form. I understand that I am free to address any specific
questions regarding this form by submitting those questions in writing prior to signing,
and I agree that my failure to do so will be interpreted as a free and knowledgeable
acceptance of the terms of this consent form.
Athlete’s Name: __________________________
Athlete’s Signature (If 18 years of age or older): _______________________
Date: ____________________
Parent/Guardian’s Name: __________________________
Child’s Name: __________________________
Parent/Guardian’s Signature (If under 18 years of age): ____________________
Date: ____________________
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