Model Release Form
My real name is: _____________________________
I wish to be known as: _____________________________ (*model name)
My date of birth is: _________/_________/___________
I understand that photographs taken of me by Mark Page (Photoswithattitude) on or about ____/____/_____ may be used wholly or in part, printed or electronically in Magazines, Books, Calendars, Internet, Portfolios, Exhibition or for Editorial and Advertising use.
The photographs taken may be used to represent an imaginary person. Any wording associated with the image will not be attributed to me personally unless I give express consent.
*Please tick here if you authorize your model name to be used and associated with the pictures.
I acknowledge by signing this form and subject to any separate restrictions stipulated and agreed in writing overleaf, that I give the following rights and make the following releases to all claims of ownership, income, editorial control and use of the resulting photographs, and assign all copyright ownership to the photographer and that no further payment will be due.
I acknowledge that use of the photographs may be granted to third parties, by either model or photographer but the photographs will always remain the property of, and should always be credited to Mark Page (Photoswithattitude).
I understand that by signing this form I give Mark Page, his heirs, legal representatives and assigns, or those for whom the photographer is acting, or those acting with his/her authority and permission:
‘full’ publication rights to ‘all’ images taken on or about the date above.
(Please be aware of these facts and give serious consideration to it’s implications; If at a later date you no longer wish to be a model or have images of yourself removed from the internet or publications you have no rights to demand such. This is a legally binding contract).
I have read this form carefully and fully understand its content, meanings and implications.
Signed:_____________________________________ Date ___/_____/______
Address:__________________________________________________________________
Town:__________________________ County: ________ Postal Code:_________
Country:____________________ Phone:_____________________________
Email Address:_____________________________________________________________
I ___________________________ confirm that this Model Release was signed in my presence
_________________________ and that I was presented at the time with adequate proof of age showing him/her to be over the age of 18.
