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The Media Consent Form is a crucial legal document used in the Netherlands when organizations need to capture, store, and use an individual's image, voice, or likeness in any form of media. This document is essential for compliance with both Dutch national law, particularly regarding portrait rights (portretrecht), and EU-wide GDPR requirements. The form should be used whenever an organization plans to create, store, or publish media content featuring identifiable individuals, whether for commercial, educational, or promotional purposes. It includes comprehensive details about the intended usage, storage duration, distribution channels, and the subject's rights, including the right to withdraw consent. The Media Consent Form must be obtained before any media capture or usage and should be maintained as part of the organization's data protection documentation.

1. Parties: Identification of the organization requesting consent and the individual (data subject) granting consent, including full names, addresses, and contact details

2. Background: Brief explanation of why the consent is being requested and the context of the media capture and usage

3. Definitions: Clear definitions of key terms used in the form, including 'Media Content', 'Usage Rights', 'Publication Channels', etc.

4. Scope of Consent: Detailed description of what media types are covered (photos, videos, audio recordings, etc.) and how they will be used

5. Usage Rights Granted: Specific permissions being granted, including platforms, contexts, and duration of usage

6. Data Protection Notice: GDPR-compliant explanation of how personal data will be processed, stored, and protected

7. Withdrawal of Consent: Clear explanation of the right to withdraw consent and the process for doing so

8. Duration and Territory: Specification of how long the consent remains valid and the geographic scope of usage

9. Signatures: Space for dated signatures of all parties, including any required witness signatures