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Testimonial Consent and Release Form Template

General Guideline for A Consent and Release Form

  • The Written and/or Video Testimonial Consent and Release should be signed by your customer or expert to acknowledge consent for the use of their personal endorsement of your product or service.
  • You will need this for every testimonial (written or video) that you want to use.
  • Before using any written or video testimonial, it is important to secure consent from the speaker or writer of the testimonial. It is not enough that a customer or expert has written you a letter praising your product or service or has spoken to you with positive comments. To reuse those statements in any form of promotional context, the person who spoke or wrote them must first give you their consent.
  • This Written and/or Video Testimonial Consent and Release form is very broad and grants you considerable usage rights. You may wish to outline the proposed use of the written or video testimonial in letter form to the individual to whom you are sending the consent, along with a customized copy of this Written and/or Video Testimonial Consent and Release.
  • If you propose to use picture of the individual in your advertisement, you will also need consent for the use of that individual’s likeness- see the “Talent/Model Release”.
  • Also note that if the person providing the testimonial is a minor (under the age of 18), you should have the child’s parent or guardian also acknowledge their Written and/or Video Testimonial Consent and Release.

Written and/or Video Testimonial Consent and Release Sample Template



Written and/or Video Testimonial Release Form

Date: ___________________________

Written Testimonial Statement and/or Inventory of Testimonial Materials (for those participating in a written testimonial only):







Authorization and Release Information

I understand my testimonial as outlined above or in the video recorded of me (the “Testimonial”) and made on behalf of [Business Name] (hereinafter called “The Business”) may be used in connection with publicizing and promoting The Business. I authorize The Business to use my name, brief biographical information, and the Testimonial as defined on this form or by me in this video.

I hereby irrevocably authorize The Business to copy, exhibit, publish or distribute the Testimonial for purposes of publicizing The Business’ programs or for any other lawful purpose. These statements may be used in printed publications, multimedia presentations, on websites, or in any other distribution media. I agree that I will make no monetary or other claims against The Business for the use of the statement.

In addition, I waive any right to inspect or approve the finished product, including a written copy or edited video wherein my likeness or my testimonial appears.

I hereby hold harmless and release The Business from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

Signature: _________________________________________

I have read the authorization and release information and give my consent for the use as indicated above.

Printed Name:  _________________________________________

Signature:         ________________________________________

Email:               ________________________________________

Address:           ________________________________________

City, State, Zip: ________________________________________

Telephone:         _______________________________________

Date:                 _______________________________________



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