Photo and Video Release Form | Media Consent for Group Homes and Independent Living Facilities | Word & PDF

Media Release Consent Form – Photo & Video Permission Template
Create a clear process for obtaining resident permission to use photos, videos, recordings, and other media with this customizable Media Release & Consent Form Template.
Designed for independent living facilities, group homes, transitional housing programs, supportive housing programs, and other residential organizations, this template provides a professional way for residents or authorized guardians to indicate whether they grant or deny permission for certain uses of their image or recordings.
The form can be incorporated into your resident intake, admission, onboarding, or administrative documentation and customized to reflect your organization's media practices.
What's Included
Your digital download includes:
Media Release & Consent Form
Photo Release Authorization
Video & Recording Authorization
Resident Permission Section
Guardian Authorization Section
Media Use Acknowledgment
Signature & Date Fields
PDF Format
Microsoft Word Format
Covers Common Media Uses
Customize the form to address your organization's use of photos, videos, or recordings for purposes such as:
Social Media
Website Content
Marketing Materials
Promotional Materials
Facility Publications
Printed Materials
Internal Documentation
Program Activities
Other Approved Media Uses
Perfect For
This media consent template is ideal for:
Independent Living Facilities
Group Homes
Transitional Housing Programs
Supportive Housing Programs
Shared Housing Programs
Residential Programs
Adult Living Programs
Housing Program Operators
Program Administrators
Create a Clear Media Permission Process
Organizations may take photographs or videos during activities, events, programs, or everyday operations. A written media consent form provides a structured way to document an individual's preferences regarding the use of their image or recordings.
Use this template to help:
✓ Request photo and video permission
✓ Document consent or refusal
✓ Explain potential media uses
✓ Obtain resident or guardian authorization
✓ Maintain organized consent records
✓ Establish a consistent media authorization process
Customizable Word & PDF Files
The listing includes both PDF and Microsoft Word formats, allowing you to adapt applicable portions of the form to your organization.
Customize the document with your facility name, contact information, specific media uses, policies, and other program-specific information.
Digital Download
This is a digital product. No physical item will be shipped.
After purchase, download your files, customize the applicable sections, and print or maintain digital copies for your organization's records.
Important Disclaimer
This template is provided for general informational and administrative purposes only and does not constitute legal, privacy, licensing, regulatory, or compliance advice.
Privacy, publicity rights, consent, photography, recording, resident rights, and media-use requirements may vary by state, facility type, age of the resident, and jurisdiction.
Organizations should review and customize the form for their specific circumstances and obtain appropriate professional guidance when necessary.