MODEL RELEASE FORM Date :
To : (the Photographer)
Address :
Email : Tel. No. :
From : (the Model)
Address :
Email : Tel. No. :
Subject : The photographs of the Model taken by the Photographer (the Photographs)
Date(s) :
Location(s) :
I, the Model, hereby irrevocably grant you, the Photographer, the rights to take the Photographs and to produce, publish,
distribute, exhibit, broadcast, use and exploit the Photographs and any derivation thereof, including to alter, adapt or edit
the same, in any manner the Photographer deems suitable in any media whatsoever subject to the following conditions:
The Photographs and any derivation thereof can be used wholly or in part in any publication, portfolio and/or public
display, for any purpose, commercial or otherwise.
To the extent it is within the Photographer’s reasonable control, the Photographs and any derivation thereof shall not
be used in any way that is derogatory, offensive or against the local culture.
Any other special conditions agreed between the Model and the Photographer for the use of the Photographs:
I waive any right of credit, approval and/or further involvement in the publication and/or dissemination of the
Photographs and any derivation thereof.
Subject to the conditions stipulated above, I hereby irrevocably and absolutely waive all rights and claims of ownership of
the Photographs and any derivation thereof, including but not limited to any intellectual property rights, image rights,
moral rights and/or any other rights in connection thereof, and I further agree that all such rights shall belong exclusively
to the Photographer and shall vest immediately with the Photographer upon the creation of the Photographs and any
derivation thereof. The right to use the Photographs or any derivation thereof may be granted, transferred or assigned by
the Photographer to any third party subject to the terms and conditions of this release.
I confirm that my participation and appearance in the Photographs are voluntary and free of charge or, if for a fee, that all
fees have been paid in full to me and there shall be no other payment or royalty due to me in respect of the Photographs
and any derivation thereof.
I confirm that I am 18 years of age or older and that I have read the terms and conditions of this release and fully
understand its contents. I understand that I am free to address any specific questions regarding this release by submitting
those questions in writing prior to signing, and that my failure to do so will be interpreted as a free and knowledgeable
acceptance of the terms and conditions of this release.
Model : Photographer :
Signature Signature
HIPA | Model Release Form v2.0 | 131014 1
If the Model is under 18 years of age, this release form shall be signed by a parent or the legal guardian of the Model:
I confirm that I am the parent / the legal guardian of the Model and that I have read the terms and conditions of this
release and fully understand its contents. I understand that I am free to address any specific questions regarding this
release by submitting those questions in writing prior to signing, and that my failure to do so will be interpreted as a free
and knowledgeable acceptance of the terms and conditions of this release.
Parent / Legal Guardian : Signature
Name :
Address :
Email : Tel. No. :
HIPA | Model Release Form v2.0 | 131014 2
