Model Release
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1Model Release
Attach Visual Reference of Model here:
(Aligned to top right-hand corner if larger than box.)
For Consideration herein acknowledged as received, and by signing
For example, Polaroid, drivers license, print, photocopy, etc.
this release I hereby give the Photographer / Filmmaker and Assigns
my permission to license the Content and to use the Content 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 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 other ethnicities may be
associated with me by the Photographer / Filmmaker and / or
Assigns for descriptive purposes.
I agree that I have no rights to the Content, and all rights to the
Content belong to the Photographer / Filmmaker and Assigns. I
Model Information
acknowledge and agree that I have no further right to additional
Name (print) _____________________________________________________
consideration or accounting, and that I will make no further claim
for any reason to Photographer / Filmmaker and / or Assigns. I
Date of Birth
___________________________________________
(DD/MM/YEAR)
acknowledge and agree that this release is binding upon my heirs
Gender: male
female
and assigns. I agree that this release is irrevocable, worldwide and
perpetual, and will be governed by the laws (excluding the law of
Model (or Parent*) Information
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 Address _______________________________________________
Alberta, England, Australia and New Zealand.
________________________________________________________________
It is agreed that my personal information will not be made publicly
City __________________________________ State/Province _____________
available but may only be used directly in relation to the licensing of
Country _____________________________ Zip/Postal Code _____________
the Content where necessary (e.g. to defend claims, protect rights
Phone _______________________ Email _____________________________
or notify trade unions) and may be retained as long as necessary
to fulfill this purpose, including by being shared with sub-licensees
Signature _______________________________________________________
/ assignees of the Photographer / Filmmaker and transferred to
Date signed
___________________________________________
countries with differing data protection and privacy laws where it may
(DD/MM/YEAR)
be stored, accessed and used. I represent and warrant that I am at
*If Model is a minor or lacks capacity in the jurisdiction of residence, Parent
least 18 years of age and have the full legal capacity to execute this
warrants and represents that Parent is the legal guardian of Model, and has
release.
the full legal capacity to consent to the Shoot and to execute this release OF
ALL RIGHTS IN MODEL’S CONTENT. If you are signing in this capacity, please
Definitions: “ASSIGNS” means a person or any company to whom
enter your details above and your name below.
Photographer/Filmmaker has assigned or licensed rights under this
release as well as the licensees of any such person or company.
Parent Name:___________________________________________________
“CONSIDERATION” means $1 or something else of value I have received
if applicable.
in exchange for the rights granted by me in this release. “CONTENT”
means all photographs, film, audio, or other recording, still or moving,
taken of me as part of the Shoot. “MEDIA” means all media including
Additional information to be completed by Model: (Optional)
digital, electronic, print, television, film, radio and other media now
Ethnicity information is requested for descriptive purposes only, and serves
known or to be invented. “MODEL” means me and includes my
as a means of providing more accuracy in assigning search words.
appearance, likeness and voice. “PARENT” means the parent and/or
legal guardian of the Model. Parent and Model are referred to together
___Asian - circle all that applies to you:
as “I” and “me” in this release, as the context dictates. “PHOTOGRAPHER
(Chinese, Japanese, Korean, Indian, other)
/ FILMMAKER” means photographer, illustrator, filmmaker or
___Caucasian, White ___Hispanic, Latin
cinematographer, or any other person or entity photographing or
___Middle Eastern
___Native American
___Pacific Islander
recording me. “SHOOT” means the photographic, film or recording
___Black
___Mixed Race
___African American
session described in this form.
Other: __________________________________________________
Photographer/Filmmaker Information
Name (print) _________________________________________________
Witness
(NOTE: All persons signing and witnessing must be of legal age and
Signature ___________________________________________________
capacity in the area in which this Release is signed. A person cannot witness their
own release)
Date signed
_______________________________________
(DD/MM/YEAR)
Name (print) _____________________________________________________
Shoot Date __________________________________________________
Signature _______________________________________________________
Shoot Country & Region/State __________________________________
Date signed
___________________________________________
(DD/MM/YEAR)
Shoot Description/Ref.
________________________________
(if applicable)
Adult & Minor Release - English - December 2008
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