Model Release Form - Ashburton District Council printable pdf download

MODEL RELEASE FORM

I hereby irrevocably grant to the Ashburton District Council (ADC) and its licensees and assignees the full right and permission to use and

publish my photographic image of me in whole or in part in any form of media or for any other lawful purpose in relation to any promotion

or communication relating to the Ashburton District Council or its activities or to any organisation that the Ashburton District Council

funds, sponsors or supports in any way. I release ADC from any liability in connection with the image(s) or recording(s).

I understand and agree that photographic images of me may be cropped, altered, transformed or reproduced in any way and may also

be combined with other works or text.

I waive any right that I may have to inspect or approve any product or copy prior to its use.

I am legally entitled to authorise this use and have read and fully understood the above authorisation. This release shall be binding upon me.

Name of model: ______________________________________________________________________________________________

Signature of model: ________________________________________________________ Date: _____________________________

Model contact details

Address: _________________________________________________________________ City: _____________________________

Phone: ___________________________________________ Alternative contact phone: __________________________________

If model is under 18

I, ________________________________________________, am the parent/legal guardian of the individual named above, I have

read this release, understand and agree to its terms.

Print Name: _________________________________________________________________________________________________

Signature: _______________________________________________________________ Date: _____________________________

Photographers use only

Photo / file name: ____________________________________________________________________________________________

Identifying characteristics: _____________________________________________________________________________________

Good luck with your entry.

Thank you for entering Ashburton District Council’s Photography Competition.

Phone 03 307 7700 or visit our website ashburtondc.govt.nz • Entries close 5pm Monday 26 October 2015

Model Release Form - Ashburton District Council