Media Consent and Release Form

I understand I will not be paid or compensated, now or in the future for my participation in this show. I hereby give my consent to Savvy Cleaner and agents, to use my image and likeness and/or any interview statements from me in its publications, advertising or other media activities (including the Internet).

This consent includes, but is not limited to:

1. YES (a) Permission to interview, film, photograph, tape, or otherwise make a video reproduction of me and/or record my voice;

2. YES (b) Permission to use my name; and

3. YES (c) Permission to use quotes from the interview(s) (or excerpts of such quotes), the film, photograph(s), tape(s) or reproduction(s) of me, and/or recording of my voice, in part or in whole, in its publications, in newspapers, magazines and other print media, on television, radio and electronic media (including the Internet), in theatrical media and/or in mailings for educational and awareness.

This consent is given in perpetuity and does not require prior approval by me.

YES. I certify that I am 18 years of age or older and have the authority to authorize the use of my participation.

By clicking the consent form and including my name, I agree to the above terms.

Privacy Policy

Yes, I agree to the Media Release Terms / NOTE: Your physical address is required for the media consent form. It is confidential and will not be shared, spammed, or sold. Your Media Participation card will be sent here.