(Put your contact details here)
Date of Birth
For consideration herein acknowledged as received, and by signing
this release, I hereby give the Photographer/Filmmaker and/or
Assignees my permission to license the Content and to use the
Content in any Media for any purpose (except pornographic or
Model (or Parent*) Information
defamatory) which may include, among others, advertising, promotion,
marketing and packaging for any product or service.
I agree that the Content may be combined with other images, text,
graphics, film, audio, audio-visual works; and may be cropped, altered
or modified. I acknowledge and agree that I have consented to
publication of my ethnicity(ies) as indicated below, but understand that
Country _____________________________ Zip/Postal
other ethnicities may be associated with me by the
Photographer/Filmmaker and/or Assignees for descriptive purposes.
Phone _______________________ Email
I agree that I have no rights to the Content, and all rights to the
Content belong to the Photographer/Filmmaker and Assignees. 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 Assignees. I
acknowledge and agree that this release is binding upon my heirs and
assignees. I agree that this release is irrevocable, worldwide and
perpetual, and will be governed by the laws (excluding the law of
*If Model is a minor or lacks capacity in the jurisdiction of
conflicts) of the country/state from the following list that is nearest to
the address of the Model (or Parent*) given opposite: New York,
residence, Parent warrants and represents that Parent is the
Alberta, England, Australia and New Zealand.
legal guardian of Model, and has the full legal capacity to
consent to the Shoot and to execute this release OF ALL
It is agreed that my personal information will not be made publicly
RIGHTS IN MODEL’S CONTENT. If you are signing in this
available but may only be used directly in relation to the licensing of
capacity, please enter your details above and your name
the Content where necessary (e.g. to defend claims, protect rights or
notify trade unions) and may be retained as long as necessary to fulfil
this purpose, including by being shared with sub-licensees/assignees
Parent Name:_________________________ if applicable.
of the Photographer/Filmmaker and transferred to countries with
differing data protection and privacy laws where it may be stored,
accessed and used. I represent and warrant that I am at least 18
Additional information to be completed by Model:
years of age and have the full legal capacity to execute this release.
Ethnicity information is requested for descriptive purposes
Definitions: “ASSIGNEES” means a person or any company to whom
only, and serves as a means of providing more accuracy in
the Photographer/Filmmaker has assigned or licensed rights under
assigning search words.
this release as well as the licensees of any such person or company.
___Asian - circle all that applies to you:
“CONSIDERATION” means $1 or something else of value I have
(Chinese, Japanese, Korean, Indian, other)
received in exchange for the rights granted by me in this release.
“CONTENT” means all photographs, film, audio, or other recording,
___Caucasian, White ___Hispanic, Latin
still or moving, taken of me as part of the Shoot.
___Middle Eastern ___Native American ___Pacific Islander
“MEDIA” means all media including digital, electronic, print, television,
___Black ___Mixed Race ___African American
film, radio and other media now known or to be invented. “MODEL”
means me and includes my appearance, likeness and voice.
“PARENT” means the parent and/or legal guardian of the Model.
Attach Visual reference of Model here:
Parent and Model are referred to together as “I” and “me” in this
(Aligned to top right-hand corner if larger than box.)
release, as the context dictates.
“PHOTOGRAPHER/ FILMMAKER” means photographer, illustrator,
For example, Polaroid, drivers license, print, photocopy,
filmmaker or cinematographer, or any other person or entity
photographing or recording me. “SHOOT” means the photographic,
Witness (NOTE: All persons signing and witnessing must be of legal
film or recording session described in this form.
age and capacity in the area in which this Release is signed. A person
cannot witness their own release)
Shoot Country & Region/State