"Media Release Form" - Vermont

Media Release Form is a legal document that was released by the Vermont Department of Corrections - a government authority operating within Vermont.

Form Details:

  • Released on May 1, 2013;
  • The latest edition currently provided by the Vermont Department of Corrections;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Vermont Department of Corrections.

ADVERTISEMENT
ADVERTISEMENT

Download "Media Release Form" - Vermont

848 times
Rate (4.5 / 5) 59 votes
VERMONT DEPARTMENT OF CORRECTIONS
MEDIA RELEASE FORM
Inmate’s Name: _________________________________ DOB: ________________________
Media Organization: ___________________________________________________________
I, the above named individual, freely give permission to the above named media
organization to publish my name and information. I grant these permissions freely and
voluntarily and further agree to hold the Department of Corrections harmless from any
and all actions that may arise as a result of this media representation. I further
acknowledge that my consent to such use of this information is done without monetary
advantage.
I understand that the Department of Corrections and the media organization retains the
discretion whether to use this information or not.
Inmate Signature: ____________________________________ Date Signed: ____________
Witness Signature: ___________________________________
Date Signed: ____________
VERMONT DEPARTMENT OF CORRECTIONS
MEDIA RELEASE FORM
Inmate’s Name: _________________________________ DOB: ________________________
Media Organization: ___________________________________________________________
I, the above named individual, freely give permission to the above named media
organization to publish my name and information. I grant these permissions freely and
voluntarily and further agree to hold the Department of Corrections harmless from any
and all actions that may arise as a result of this media representation. I further
acknowledge that my consent to such use of this information is done without monetary
advantage.
I understand that the Department of Corrections and the media organization retains the
discretion whether to use this information or not.
Inmate Signature: ____________________________________ Date Signed: ____________
Witness Signature: ___________________________________
Date Signed: ____________