Bereavement Doula Media Release Form

Our Bereavement Doula Media Release Form is a professional, customizable document created to support bereavement doulas and the clients they serve when sharing photos, videos, or other media connected to end-of-life, grief, or loss support. This form ensures that clear, informed, and compassionate consent is obtained before any media is used. It also addresses media that may include partners, family members, support persons, or minors present during sensitive moments. By outlining expectations with care, this form protects client privacy, upholds emotional boundaries, and fosters trust throughout the bereavement process.

Key Sections of the Bereavement Doula Media Release Form:

Client and Doula Information:
Collects essential contact information for both the doula and the client to ensure all parties are clearly identified.

Purpose of Media Use:
Describes the specific ways media may be used, including websites, social media, marketing materials, educational content, training, or other media outlets.

Client Consent:
Provides a dedicated space where the client grants permission for the use of photos, videos, or recordings for agreed-upon uses, including the presence of family members or minors.

Right to Modify and Edit Media:
Clarifies whether the doula has permission to edit, crop, or adjust media when preparing it for professional, educational, or supportive materials.

Confidentiality and Privacy:
Emphasizes respect, sensitivity, and discretion when handling media that may capture deeply emotional or private moments connected to grief and loss.

Compensation or No Compensation:
Indicates whether the client receives compensation or is providing consent without any form of payment.

Time Period of Consent:
Specifies how long consent remains valid and whether it applies to future materials.

Revocation of Consent:
Explains how clients can withdraw consent and request that media be removed or discontinued from use.

Client Acknowledgment and Signature:
Provides space for the client to confirm their understanding and agreement with all terms outlined in the release.

Key Features:

• Easy to Edit: Fully customizable to fit your bereavement doula practice and client needs
• Print-Ready: Professionally formatted for clean, easy printing
• Email-Friendly: Simple to download, complete, and share digitally
• Clear Consent Terms: Written with gentle, client-centered language to support understanding and comfort

How It Works:

• Purchase the Template: Access digital files instantly
• Edit the Template: Personalize the form in Microsoft Word with your business details and media-use policies
• Save and Use: Provide the form to clients to obtain consent before sharing any media connected to bereavement support

Please Note:

• Personal Use Only: Redistribution or resale is not permitted
• Digital Product: No physical item will be mailed
• All Sales Are Final: Digital products are non-refundable

A thoughtful media release form helps bereavement doulas uphold privacy, maintain professionalism, and ensure all media is used with compassion and consent. This template supports clear communication and trust throughout your bereavement doula practice.