Model release sample or example

 
Sample Model Release
 












Date:
Production Number:
 
Photographer:
 
Description:
 


In consideration of my services as a model, I hereby agree as follows:


1. I hereby irrevocably grant to Photographer, the absolute and unconditional, worldwide right, in perpetuity, without right to any further payment, to use, re-use, transmit, display, sell, license, copyright, and publish my portrait, likeness, picture, and image (collectively "My Likeness") in any photographs, images, recording footage, video, art or illustrations (collectively “Images"), without restriction, in any and all media now known, or hereafter invented, including without limitation, art, advertising, stock photography, stock video/footage, stock film, digital or electronic media, print, broadcast, Internet, promotions, commercial and non-commercial use, or for any other purpose throughout the world

2. I agree that the Images may be combined with other images, text and graphics and cropped, altered, or modified. I waive all right to view, inspect or approve any product, text, advertisement or any other use of any Images that contain My Likeness and I agree that no use of the Images need be submitted to me for approval.

3. I hereby irrevocably agree to forever waive and release any claim that I or my successors or assigns have, or may have, against the photographer based on any rights of privacy, publicity or any other right that may arise from, or be related to, the use, license, modification (including blurring, altering or distorting whether intentional or otherwise), distribution, publication or reproduction of My Likeness in any and all media.

4. This Model Release is for the production described above and all other prior productions. This Model Release may not be changed or modified orally, and I agree that this writing represents the entire understanding between the photographer and myself. I further acknowledge that the photographer may assign his or her rights under this Model Release to any third party.

5. If any provision of this Mode Release is determined by a court of law to be invalid, now or unenforceable in any jurisdiction, then this Model Release shall be construed so as to effect the widest possible grant of right without violating the law of the jurisdiction. Any dispute related to this Model Release shall only be brought by the parties in the Federal Courts of the State of New York, United States, which courts shall have exclusive jurisdiction over any matters related to this Model Release.

6. I represent and warrant that I (i) am of full legal age in the jurisdiction in which this Model Release is executed; (ii) am of full legal capacity; (iii) enter into this Model Release voluntarily; (iv) have not granted any rights that conflict with those granted herein; and (v) have every right to contract in my own name and grant the rights herein. I have read this Model Release, prior to its execution, and I agree with its terms.


Model's Name:
 

Model's Signature:
 

Date of Birth:
 

Model's Address:
 

Phone:
 

Email:
 

Model's Tax ID/Driver's License Number:
 





Ethnicity information is requested for descriptive purposes only and serves as a means of providing more accuracy in assigning image search words. Mark each that applies to model:

 
Asian
 
Hispanic, Latin
 
Caucasian, White
 
African American
 
Native American
 
Middle Eastern
 
Mixed (please describe)



Witness Signature:

Witness Printed Name:

Witness Address:







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Copyright © 2016 Koren Reyes. A Newport, RI and NYC portrait photographer.
Beautiful, classic portraiture of families, but especially women, children and dogs.
All rights reserved.