Photo & Video release form
Permit to take your photo & video and authorize publish
Email address *
Full Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Ethnicity *
Your answer
Shoot Location *
Your answer
Phone *
Your answer
Your Address *
Your answer
Insta/FB/Other Social Media Handle *
Your answer
Shoot Date *
MM
/
DD
/
YYYY
Shoot Title *
Your answer
Shoot Type *
Parent's Name (If your age is below 18). If not please specify NA. The below agreement must be signed by Parent/Guardian if you are a minor. *
Your answer
RELEASE AGREEMENT
For Consideration herein acknowledged as received, and by signing this release I hereby give the Photographer / Filmmaker and Assigns my permission to license the Content and to use the Content in any Media for any purpose (except pornographic or defamatory) which may include, among others, advertising, promotion, marketing and packaging for any product or service. I agree that the Content may be combined with other images, text, graphics, film, audio, audio-visual works; and may be cropped, altered or modified. I acknowledge and agree that I have consented to publication of my ethnicity(ies) and gender as indicated below, but understand that other ethnicities or gender may be associated with me by the Photographer / Filmmaker and / or Assigns for descriptive purposes. I agree that I have no rights to the Content, and all rights to the Content belong to the Photographer / Filmmaker and Assigns. I acknowledge and agree that I have no further right to additional consideration or accounting, and that I will make no further claim for any reason to Photographer / Filmmaker and / or Assigns. I acknowledge and agree that this release is binding upon my heirs and assigns. I agree that this release is irrevocable, worldwide and perpetual, and will be governed by the laws (excluding the law of conflicts) of the country/state from the following list that is nearest to the address of the Model (or Parent*) given opposite: New York, Alberta, England, Australia and New Zealand. It is agreed that my personal information will not be made publicly available but may only be used directly in relation to the licensing of the Content where necessary (e.g. to defend claims, protect rights or notify trade unions) and may be retained as long as necessary to fulfill this purpose, including by being shared with sub-licensees / assignees of the Photographer / Filmmaker and transferred to countries with differing data protection and privacy laws where it may be stored, accessed and used. I represent and warrant that I am at least 18 years of age and have the full legal capacity to execute this release. Definitions: “ASSIGNS” means a person or any company to whom Photographer/Filmmaker has assigned or licensed rights under this release as well as the licensees of any such person or company. “CONSIDERATION” means $1 or something else of value I have received in exchange for the rights granted by me in this release. “CONTENT” means all photographs, film, audio, or other recording, still or moving, taken of me as part of the Shoot. “MEDIA” means all media including digital, electronic, print, television, film, radio and other media now known or to be invented. “MODEL” means me and includes my appearance, likeness and voice. “PARENT” means the parent and/or legal guardian of the Model. Parent and Model are referred to together as “I” and “me” in this release, as the context dictates. “PHOTOGRAPHER / FILMMAKER” means photographer, illustrator, filmmaker or cinematographer, or any other person or entity photographing or recording me. “SHOOT” means the photographic, film or recording session described in this form.

Release of liability waiver
I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING AND/OR VOLUNTEERING IN THIS ACTIVITY OR EVENT, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. I certify that I am physically fit, have sufficiently prepared or trained for participation in the activity or event, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity or event. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity or event in which I may participate, and that it will govern my actions and responsibilities at said activity or event. In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: Photographer, Magazine, their directors, officers, employees, volunteers, representatives, and agents, the activity or event holders, activity or event sponsors, activity or event volunteers; (B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity or event, whether caused by the negligence of release or otherwise. I acknowledge that the Event Organizers and their directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific event or activity on behalf of anyone. I acknowledge that this activity or event may involve physical activity, and may carry with it the potential for death, serious injury, and property loss. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity or event. I understand that at this event or related activities, I or my properties may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers, and assigns. The accident waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL. PARENT / GUARDIAN WAIVER FOR MINORS (Under 18 years old) The undersigned parent and natural guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or ward’s participation in the activity or event, and has agreed individually and on behalf of the child or ward, to the terms of the accident waiver and release of liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian.
Image release agreement

Photos shared by the photographer or photography agency cannot be modified or sold or used for commercial purposes like using it as a catalog on website without proper permission or releases by the photographer or photography agency. The images can and will be used by Model/photographer for portfolio use and for any magazine relevant to the theme.
I acknowledge & agree with this agreement. *
Required
PLEASE TYPE YOUR FULL NAME IN CAPS AS DIGITAL SIGNATURE. If you are a minor then your parent/guardian must sign this. *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy