Name of photographer:
Number or description of photograph(s):
Date of photograph(s):
Intended use of Photographs: _
For consideration listed overleaf, I (modelåØ·s name) _ _ give the above-named photographer and all licensees and assignees the absolute right to copyright and use the photograph(s) described above for the intended use listed above. It is understood and agreed by myself and the above-named photographer that any use of the photographs other than that listed above will require a separate model release and that a further fee may be levied for that use.
If the photographs are to be used in an altered or composite form then it is further agreed and understood that each of the finished images will require written approval and permission from myself prior to any use or publishing.
Both parties have read this release and are fully familiar with and understand its contents.
*I am over the age of majority and have the right to enter into this contract.
*I am not over the age of majority, but my parent/guardian agrees to these conditions.
Name of Model:
Name of parent/guardian:
Witness Name: Signature:
Signature of Photographer:_
*delete as applicable Date:_
(cross out section that does not apply)
the sum of: _ (Amount in words)
åØ· _ (Amount in figures) in respect of the agreement listed overleaf.
Signed: _ Date: _
I: _ _ (insert photographers name)
hereby agree to supply: _ (insert modelåØ·s name)
with (qty): _ _ prints from the shoot described overleaf for her to use in the
promotion of herself as a model only and that it is agreed and understood that such use should be åØ·as isåØ· in that the prints are not to be altered in any way. It is further understood and agreed that if I do not supply said prints within: (time period) _ _ that I shall be liable to
pay a fee of åØ· _ _ (in words): _ _
to the model listed overleaf.
Models signature: _ _ Date: _ _
PhotographeråØ·s signature: _ _ Date: _ _