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New York Model Release Form 1

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New York Model Release Form 1
New York Model Release Form 1
Model Release
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)
as indicated below, but understand that other ethnicities 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.
Photographer/Filmmaker Information
Name (print) _________________________________________________
Signature ___________________________________________________
Date signed
(DD/MM/YEAR) _______________________________________
Shoot Date __________________________________________________
Shoot Country & Region/State __________________________________
Shoot Description/Ref.
(if applicable) ________________________________
Model Information
Name (print) _____________________________________________________
Date of Birth
(DD/MM/YEAR) ___________________________________________
Gender: male female
Model (or Parent*) Information
Residence Address _______________________________________________
________________________________________________________________
City __________________________________ State/Province _____________
Country _____________________________ Zip/Postal Code _____________
Phone _______________________ Email _____________________________
Signature _______________________________________________________
Date signed
(DD/MM/YEAR) ___________________________________________
*If Model is a minor or lacks capacity in the jurisdiction of residence, Parent
warrants and represents that Parent is the legal guardian of Model, and has
the full legal capacity to consent to the Shoot and to execute this release OF
ALL RIGHTS IN MODEL’S CONTENT. If you are signing in this capacity, please
enter your details above and your name below.
Parent Name:___________________________________________________
if applicable.
Attach Visual Reference of Model here:
(Aligned to top right-hand corner if larger than box.)
For example, Polaroid, drivers license, print, photocopy, etc.
Witness (NOTE: All persons signing and witnessing must be of legal age and
capacity in the area in which this Release is signed. A person cannot witness their
own release)
Name (print) _____________________________________________________
Signature _______________________________________________________
Date signed
(DD/MM/YEAR) ___________________________________________
Adult & Minor Release - English - December 2008
Additional information to be completed by Model: (Optional)
Ethnicity information is requested for descriptive purposes only, and serves
as a means of providing more accuracy in assigning search words.
___Asian - circle all that applies to you:
(Chinese, Japanese, Korean, Indian, other)
___Caucasian, White ___Hispanic, Latin
___Middle Eastern ___Native American ___Pacific Islander
___Black ___Mixed Race ___African American
Other: __________________________________________________
New York Model Release Form 1