Minor Model Release Form printable pdf download

MINOR MODEL RELEASE

Model’s Name: _____________________________________________________

Attach visual reference

Model’s Address: ___________________________________________________

here, aligned to top right-

hand corner if larger than

_________________________________________________________________

box.

_________________________________________________________________

For example,

Polaroid, driver’s license,

print, photocopy, etc.

Model’s Phone: ____________________________________________________

Model’s E-mail: ____________________________________________________

PARENT/LEGAL GUARDIAN’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 model’s

ethnicity(ies) as indicated below, but understand that other ethnicities may be associated with Images of the Model 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.

Parent warrants and represents that Parent is the legal guardian of Model, and has the full legal capacity to consent to the Shoot and to

execute this release OF ALL RIGHTS IN MODEL’S IMAGES.

To be completed By Model’s Parent or Legal Guardian:

Additional Information to be completed by

Model’s Parent or Legal Guardian: (Optional)

Parent/Legal Guardian

Model’s Ethnicity information is requested for

Signature:______________________________________Date:____________

descriptive purposes only, and serves as a means of

providing more accuracy in assigning search

words.

Parent/Legal Guardian

___Asian – circle each that applies to model:

Printed Name:___________________________________________________

(Chinese, Indian, Japanese, Korean)

Model’s

___Asian, Other

___Caucasian, White

Date of Birth: ____________________

___Hispanic, Latin

___Middle Eastern

___Native American

___Pacific Islander

DEFINITIONS:

“MODEL” means my minor child and include his/her appearance, likeness and form.

___Black

___Mixed Race

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

media now known or to be invented.

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

___African American

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

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

Other: _____________________________________

or licensed rights under this release as well as the licensees of any such person or company.

“IMAGES” means all photographs, film or recording taken of Model 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

“PARENT” means the parent and/or legal guardian of the Model. Parent and Model are

referred to together as “we” and “us” in this release

____________________________________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]: ______________________________________

_________________________________________________________________________________

Minor Model Release Form

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