This is just a sample. Modify it at your will.
CONSENT AND RELEASE
I authorize _____________________________________________________________ (the Photographer) to Photograph and make other recordings and fixations of my Image (the Photograph(s)). I further authorize the Photographer to adapt, edit and modify the Photograph(s) in any manner whatsoever and to add and remove elements to the Photograph(s), including without limitation, special effects and music. Such adapted, edited and modified Photograph(s) shall also be a Photograph(s).I hereby grant to the Photographer, in perpetuity, all world-wide rights and interests of every kind and nature, whether now known or unknown, whether now existing or arising in the future, in and to the Photograph(s) and all results and proceeds therefrom, including without limitation, the incorporation of the Photograph(s) into advertising, promotional and sales materials, the incorporation of the Photograph(s) into any other production or program, commercial tie-ins or merchandising and to display, broadcast and transmit the Photograph(s) on any medium and by any means or method including print, video, DVD, television, theatrical, Internet and electronic, whether or not the same is known or in existence at this time.I further grant to the Photographer all rights to use my likeness, voice, biographic and other information in connection
with such uses.All the forgoing rights are granted in favour of the Photographer and all of its licensees, successors and assignees and any other person or entity that is granted rights in the Photograph(s) by the Photographer.I acknowledge and agree that I am at least 18 years of age and am legally entitled to execute this Consent and Release and that once executed it shall create a valid legal agreement enforceable in accordance with its terms. I further agree that I have read and understood this Consent and Release and acknowledge that I have been given the opportunity to review this Consent and Release with my lawyer.I have granted these rights in exchange for the opportunity of being involved in the Photograph(s), the potential for publicity
relating to same and other good and valuable consideration, which I hereby acknowledge is sufficient and which I have received. I further acknowledge that I will not receive any further compensation for the rights granted in this Consent and Release, except as set out below, if any.
Model
Name (print) _______________________________________________
Date ___________________________________
Signature _____________________________________________________ Phone ________________________________
Address _______________________________________________________________________________________________City _____________________________ State ________ Zip _____________ Country ________________________________
Parent or Guardian (if model is a minor)
Name (print) ________________________________________________
Signature _____________________________________________________
WitnessName (print) ________________________________________________
Signature _____________________________________________________
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