Model Release for Photograph

[Date]

For valuable consideration, the receipt and sufficiency of which is hereby acknowledged, I,
[name of model], hereby assign [name of photographer] the right to photograph me and the
irrevocable perpetual right to use the photographs that [he/she] has taken of me (in which I may
be included with others) in any and all media throughout the world in perpetuity, including but
not limited to the following rights:

(a) The right to copyright the same in [his/her] own name or any other name that [he/she]
may choose;
(b) The right to use, reuse, publish, and republish the same in whole or in part, severally or
in conjunction with other photographs and/or text, in any medium and for any purpose
whatsoever, including (but not limited to) illustration, promotion, and advertising and
trade without any compensation or further compensation to me; and
(c) The right to use my name, nickname, initials, autograph, facsimile signature, and
likeness in connections therewith if [he/she] so chooses.

I hereby release and discharge [name of photographer] and [his/her] licensees, assigns, and
successors from any and all claims and demands arising out of or in connections with the use of
the photographs, including but not limited to any and all claims for defamation, invasion of
privacy, invasion of right of publicity, and copyright infringement.

Model represents and warrants that it is the owner of and controls all right, title and interest in
and to Model’s own image and that there are not other agreements with any other party in
conflict herewith.

Nothing contained herein shall constitute this arrangement to be employment, a joint venture or a
partnership.

This authorization and release shall enure to the benefit of all legal representatives, licensees, and
assigns of [name of photographer], as well as the person(s) for whom [he/she] took the
photographs.

I have read the foregoing and fully understand the contents thereof.

Signature of Model

Print name

Address

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Phone/Fax/E-mail

Date

Witness [Optional]
[If model is a minor, parent or guardian must sign below]

I represent that I am the parent or guardian of the minor whose name appears above. I hereby
consent to the foregoing on his/her behalf.

Parent/guardian’s name:

Signature:

Address:

Date:

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