Model Release Sample Form

Model Release
For Consideration herein acknowledged as received, and
by signing 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 Conten t may be combined with other
images, text, graphics, film , audio, audio-visual works; and
may be cropped, altered or m odified. I acknowledge
and agree that I hav e consented to publication of my
ethnicity(ies) as indicated b elow, but understand that
other ethnicities may be associated with me by the
Photographer / Filmmaker and / or Assigns for descriptive
I ag ree th at I have no righ ts to the Content, and all rights
to th e Con t e nt belon g to the Ph o to g ra p h er / F ilmm a k er
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 (excluding the law of conflicts) of
the country/state fro m the following list that is nearest to
the address of the Model (or Parent*) given opposite:
New York, Alberta, England, Australia and New Zealand.
It is agreed that my personal information will not be made
publicly available but may only be used directly in
relati on to the li cens in g of th e Con t en t wher e nec es s ary
(e.g. to defend claims, protect rights or notify trade
unions) and may be retained as long as necessary to fulfill
this purpose, including by being shared with sub-licensees
/ assignees 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 years of age
and have the full legal capacity to execute this release.
Definitions: “ASSIGNS” means a person or any company to
whom Photographer/Filmmaker has assigned or licensed
rights under this release as well as the licensees of any
such person or company. “CONSIDERATION” means $1 or
something else of value I have received in exchange for
the rights granted by me in this rel ease. “CO NTENT” means
all photographs, film, audio, or other recording, still or
moving, taken of me as part of the Shoot. “MEDIA” means
all media including digital, electronic, print, television, 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. Parent and Model are
referred to together as “I” and “me” in this release, as the
context dictates. “PHOTOGRA PHER / FILMMAKER” means
photographer, illustrator, filmmaker or cinematographer,
or any other person or entity photographing or recording
me. “SHOOT” means the photographic, film or recording
session described in this form.
Photographer/Filmmaker Information
Name (print)
Date Signed (
Shoot Date
Shoot Country & Region/State
Shoot Description/Ref. (if applicable)
Attach Visual Reference of Model here:
(Aligned to top right-hand corner if larger than box.)
For example, Polaroid, drivers license, print, photocopy,
Model Information
Name (print)
Date of Birth (DD/MM/YEAR)
Gender male [ ] female [ ]
Model (or Parent*) Information
Residence Address
City State/Province
Country Zip/Postal Code
Phone Email
Date Signed (
*If Model is a minor or lacks capacity in the jurisdiction of
residence, Parent warrants and represents that Parent is the
legal guardian of Model, and has the full legal capacity to
consent to the Shoo t a nd to execu te thi s rel e ase OF ALL
RIGHTS IN MODEL’S CONTENT. If you are signing in this
capacity, please enter your details above and your name
Parent Name:
if applicable
Additional information to be completed by Model:
Ethnicity information is requested for descriptive purposes
only, and serves as a means of providing more accuracy
in assigning search words.
___Asian – circle all that applies to you:
(Chinese, Indian, Japanese, K orean, othe r)
___ Caucasian, White___Hispanic, Latin
___Middle Eastern ___Native American ___Pacific Islander
___Black ___Mixed Race ___African American
Witness (NOTE: All persons signing and witnessing must be of
legal age and capacity in the area in which this Release is
signed. A person cannot witness their own release)
Name (print)
Date Signed (DD/MM/YEAR)
Model Release – English – Dec 2008
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