Photographic Release Form
Photographic Release Form
For valuable consideration, I _______________________ hereby grant to __________, his subsidiaries, affiliates,
nominees, licenses, their successors and assigns, and those acting with his authority (hereinafter referred to
collectively as “Photographer”), with respect to the photographs taken of me by Photographer (the “Pictures”), the
unrestricted absolute, perpetual, worldwide right to:
(a) Reproduce, copy, modify, creative derivatives I whole or in art, or otherwise use the Pictures or any part
thereof in combination with or as a composite of other matter, including, but not limited to, text, data,
images, photographs, illustrations, animations and graphics, video or audio segments of any nature, in any
media or embodiment, now known or hereafter to become known (the “Work”).
(b) Use and permit to be used my name, whether in original or modified form, in connection with the Work as
Photographer may choose.
(c) Display, perform, exhibit, distribute, transmit or broadcast the Work by any means now known or hereafter
to become known.
I hereby waive all rights to the Pictures, and all rights to the Pictures belong to the Photographer. I acknowledge
and agree that I have no further right to additional consideration or accounting. I shall neither sure nor bring any
proceeding against any such parties for, any claim, demand or cause of action whether now known or unknown,
for defamation, invasion of right to privacy, publicity or personality or any similar matter, or based upon or relating
to the use and exploitation of the Pictures.
I agree that there shall be no obligation to utilize the authorization granted by me hereunder. The terms of this
authorization shall commence on the date hereof and be without limitation.
I represent and warrant that I am _______________________ (inter ‘under’ or ‘over’) the age of 18 years and that
I am free to enter into the agreement.
Photographer Information
Name (print): ___________________________________
Signature: _____________________________________
Date Signed (DD/MM/YYYY): _______________________
Date Picture Taken: ______________________________
Brief Shoot Description: __________________________
Subject Information
Name (print): ___________________________________
Date of Birth (DD/MM/YYYY): ______________________
Phone: ____________________ Email: ______________
Signature: _____________________________________
Date Signed (DD/MM/YYYY): _______________________
*If Subject is a minor or lacks capacity in the jurisdiction of resident, Parent warrants and represents that Parent is
the legal guardian of Subject, and has 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 enter your details above and your
name below.
Parent Name (If applicable): _________________________
Witness (NOTE: all persons signing and witnessing must be of legal age and capacity in the area that this Release is signed. A person cannot
witness his or her own release).
Name (print): ___________________________________
Signature: _____________________________________
Date Signed (DD/MM/YYYY): _______________________