Model Release Form printable pdf download

Model Information

Model Release

Name (print)

____________________________________________

(Put your contact details here)

Date of Birth

(DD/MM/YEAR)

___________________________________________

For consideration herein acknowledged as received, and by signing

Gender: male/female

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,

Residence Address

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

City __________________________________

or modified. I acknowledge and agree that I have consented to

State/Province _____________

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.

Code _____________

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

Signature

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

Date signed

(DD/MM/YEAR)

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

below.

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.

(Optional)

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”

Other: ____________________________________

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

etc.

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)

Photographer/Filmmaker Information

Name (print)

____________________________________________

_________________________________________________

Signature

___________________________________________________

____________________________________________

Date signed

(DD/MM/YEAR)

Date

_______________________________________

___________________________________________

Shoot Date

__________________________________________________

Shoot Country & Region/State

__________________________________

Shoot Description/Ref.

_________________________________________

Model Release Form

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