MODEL RELEASE FORM

To the photographer: ………………………………………………………………………………………………………….
Address:………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… Phone: …………………………………………

From the model: ……………………………………………………………………………………………………(Name)
Address:………………………………………………………………………………………………………………….………………………………………………………………………………………………………………………………………………………….……………………………………………………………………………………….. Phone: …………………………………………..
Photographs taken on the date of: ………………………………………………………………………………………..
Location photographs will be taken at: ………………………………………………………………………………….

I, the model, grant you, the photographer, usage to the photographs subject to the following conditions:
•I understand that the photographs taken of me during the session can be used within the photographer’s portfolio work and possibly (will notified if so) in a public display
•That any of the photographs taken, along with any additional information given can be/will be used within any form of display, including portfolio work or public display unless agreed otherwise
•Special conditions agreed between the photographer and the model: ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..

[ ] I am happy for any information given in connection to my photograph being taken to be used within the photographers work, including both portfolio and/or public display (Please tick box if you agree to this term)
[ ] I am happy for my name to be used in connection with the photographers work, including portfolio and/or public display (Please tick box if you agree to this term)

Model: ………………………………………………… Photographer: ……………………………………………………………………….
(Both parties to sign here to agree these special conditions)

I acknowledge that by signing this form, subject to usage restrictions above, I give up all claim of ownership of the photographs and assign copyright to the photographer names above. There will be no additional payment after the date stated above. Use of photographs may be granted to third parties (you will be notified if this is the case), however, the photographs will remain the property of the photographer.

I have read this form carefully and fully understand the implications. I am 18 years or over.
Signed (model): …………………………………………………………..  Date: ……………………………………

If model is under 18 years of age, a parent/legal guardian must sign:
Parent/Guardian: …………………………………………………………….  Date: ………………………………….
Address:………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………. Phone: …………………………

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