General Media Release Form

Contact Info

First Name*

Last Name*

Email*Phone (optional)

I hereby give Million Little permission to use my story, which include quotes and identifying details, and any photos/videos/audio recordings of me without limitation or reservation. I agree to the use of my story and likeness in all of Million Little’s communications and materials, which includes, but is not limited to, print publications, social media, the internet, and Million Little’s website. I grant Million Little permission to share this information with media sources such as print or on-line publications. I waive any right to compensation for the use of my story or my likeness.

My signature indicates that I completely understand and agree to the above statement.

Filling out the field below will serve as your signature:

Signature of Volunteer (Applicant)*

Date*

Age*

Parental Consent

I certify that I am the parent or guardian of the individual above, a minor under the age of eighteen years. I hereby agree to assume legal responsibility for his/her authorizations referred to in this General Media Release.

Filling out the field below will serve as your signature:

Signature of Parent/Legal Guardian

Date

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