Model Release Form printable pdf download

MODEL RELEASE

Model’s Name: _____________________________________________________

Model’s Address: ___________________________________________________

Attach visual reference here,

aligned to top right-hand

corner if larger than box.

_________________________________________________________________

For example,

_________________________________________________________________

Polaroid, drivers license,

print, photocopy, etc.

Model’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 publication of my

ethnicity(ies) as indicated below, 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 England excluding the law of conflicts.

I represent and warrant that I am at least 18 years of age and have the full legal capacity to execute this release.

To be completed By Model:

Additional information to be completed by Model:

(Optional)

Model’s

Signature:______________________________________Date:____________

Ethnicity information is requested for descriptive

purposes only, and serves as a means of providing

Model’s

more accuracy in assigning search words.

Printed Name:___________________________________________________

___Asian – circle each that applies to you:

Model’s

Date of Birth: ____________________

(Chinese, Indian, Japanese, Korean)

___Asian, Other

___Caucasian, White

___Hispanic, Latin

___Middle Eastern

DEFINITIONS:

“MODEL” means me and includes my appearance, likeness and form.

___Native American

___Pacific Islander

“MEDIA” means all media including digital, electronic, print, television, film and other

media now known or to be invented.

___Black

___Mixed Race

“PHOTOGRAPHER/FILMMAKER” means photographer, illustrator, filmmaker or

cinematographer, or any other person or entity photographing or recording me.

___African American

“ASSIGNS” means a person or any company to whom Photographer/Filmmaker has

assigned or licensed rights under this release as well as the licensees of any such

person or company.

Other

“IMAGES” means all photographs, film or recording taken of me as part of the Shoot.

“CONSIDERATION” means something of value I have received in exchange for the

rights granted by me in this release.

“SHOOT” means the photographic or film session described in this form

__________________________________The following to be completed by Photographer/Filmmaker_________________________________

Photographer’s/Filmmaker’s Name: ______________________________________________ Shoot Date: _______________________________

Photographer/Filmmaker’s Signature: __________________________________________________

Shoot Description [and Shoot Reference if applicable]: ____________________________________

________________________________________________________________________________

Model Release Form

Related Articles

Related forms

Related Categories