Media Release & Consent Form

Organization: Overtown Children & Youth Coalition

Address: 219 NW 14th Terr. Suite 403 Miami, FL 33136

Website: OvertownCYC.org

Participant Information

Participant Full Name

If participant is under 18 years of age, completion by a parent or legal guardian is required.

Parent / Legal Guardian Information (Required for Minors)

Parent/Guardian Full Name

Media Release Authorization

I hereby grant Overtown Children & Youth Coalition (OCYC), its representatives, employees, agents, partners, and assigns, the irrevocable right and permission to photograph, record, videotape, livestream, and otherwise capture my image, likeness, voice, statements, and/or the image, likeness, and voice of the participant named above.


This authorization includes the right to use, reproduce, edit, publish, distribute, and display such media, in whole or in part, in any manner or medium now known or later developed, including but not limited to:


  • Educational and program materials
  • Marketing and promotional materials
  • Social media, websites, and digital platforms
  • Print publications, reports, and grant submissions
  • Fundraising, donor, and community outreach materials

Rights and Ownership

I understand that all photographs, video, audio recordings, and related materials are the sole property of Overtown Children & Youth Coalition. I waive any right to inspect or approve the finished product or the use to which it may be applied.

I further waive any right to royalties, compensation, or other consideration arising from the use of such media.

Duration of Consent

This release is granted in perpetuity, unless revoked in writing. Any revocation will apply only to future use and will not affect materials already produced or distributed.

Voluntary Consent

I acknowledge that participation is voluntary and that I am under no obligation to grant this consent. I affirm that I am at least 18 years of age or am the parent or legal guardian of the minor named above and have the authority to execute this release.

Electronic Signature and Acknowledgment

By checking the box below and submitting this form electronically, I acknowledge that I have read, understand, and agree to the terms of this Media Release and Consent Form. I understand that my electronic acknowledgment constitutes a legally binding signature.

Electronic Signature and Acknowledgment
Clear Signature
Consent to Receive Communications