MEDIA CONSENT FORM

----“Lights, Camera, Action!"----

This form must be completed for any videos or images that are intended for public viewing and are not for personal use (this includes all social media platforms).

Full Name

E-mail

Contact Number

Date of Filming/ Shooting

Proposed Filming Time

Media platforms where you intend to distribute the content.

Facebook.

YouTube.

Instagram.

Twitch.

Other.

If 'Other' please state below:

Media Page/ Details such as Facebook Page, YouTube Channel etc:

Please provide a short summary of the intended purpose of the filming or photoshoot below:

We expect some financial support from youtubers to increase deliver
or create more free haunted facilities.

I Agree to the Clown Motel`s Media and Filming Policy below -
( https://wwww.theclownmotelusa.com/policies)

Submit