Model Release Form printable pdf download

Model Release Form

Model’s Name: ______________________________________________

Model’s Address: ____________________________________________

Affix model photo here

___________________________________________________________

Models’s Phone: _____________________________________________

Model’s E-mail: ______________________________________________

Model’s Permission and Rights Granted

For good and valuable Consideration herein acknowledged as received, and by signing this release I hereby give the

Photographer/Filmmaker and Assigns my permission to license the Images and to use the Images in any Media for any

purpose (except pornographic or defamatory) which may include, among others, advertising, promotion, marketing and

packaging for any product or service. I agree that the Images may be combined with other images, text and graphics,

and cropped, altered or modified. I acknowledge and agree that I have consented to the publication of my ethnicity(ies)

as indicated here, but understand that other ethnicities may be associated with images of me by the

photographer/Filmmaker and / or Assigns for descriptive purposes.

I agree that I have no rights to the Images, and all rights to the Images belong to the Photographer/Filmmaker and

Assigns. I acknowledge and agree that I have no further right to additional consideration or accounting, and that I will

make no further claim for any reason to Photographer / Filmmaker and/or Assigns. I acknowledge and agree that this

release is binding upon my heirs and assigns. I agree that this release is irrevocable, worldwide and perpetual, and will

be governed by the laws of India.

I hereby declare and warrant that I am above 18 years of age in the legal jurisdiction applicable to this agreement. I

consent to the inclusion of this Model Release form including the personal details recommended in it being added to the

public database owned or operated by Mash Audio Visuals Pvt. Ltd. or its subsidiary.

To be completed by the model

To be completed by the Photographer

Date …………………...................................................

Photographer’s Name .......................…............

Model’s Signature .......................................................

Shoot Date .............................................….......

Model’s Printed Name ................................................

Photographer’s Signature........................…......

Model’s Date of Birth ..................................................

Shoot Description .............................................

Or, to be completed by the model’s parent or legal

..........................................................................

guardian (for minors):

……………………………………………………...

Date ...........................................................................

Delete as applicable......……*Parent / Legal Guardian

Definitions

“Assigns” means a person or any company to whom Mash Audio

Parent’s Name ............................................................

Visuals Pvt. Ltd. has assigned or licensed rights under this release as

well as the licensees of any such person or company.

“Consideration” means something of value I have received in

Signature ....................................................................

exchange for the rights granted by me in this release.

“Images” means all photographs taken as part of the Shoot.

Model’s Date of Birth ..................................................

“Media” means all media including digital, electronic, print,

television, film and other media now known or to be invented.

*Parent warrants and represents that Parent is the legal guardian

“Model” means me and includes my appearance, likeness and

of the Model, and has the full legal capacity to consent to the

form.

“Shoot” means the photographic or film session described in

Shoot and to execute this release OF ALL RIGHTS IN MODEL’S

this form.

IMAGES.

Witnesses (NOTE: All persons signing and witnessing must be of legal age. A person cannot witness their own

release.)

Name: _________________________________

Date: __________________________________

Signature:_______________________________

Head Office: 101-107, Vardhman Plaza, Plot No. 10, K.P. Block, Pitam Pura, Delhi-110088. Phone: +91-11-42686869, Fax: +91-11-27311070

Model Release Form

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