model release form

1. Filming, Photographic and Sound Recording Release Form
I hereby give Ben Clarke the right to use (delete as appropriate)
 video recording(s)
 sound recording(s)
 photograph(s)
of myself.
Taken on/between: 05/01/17 – 09/01/17
for use in: Media Photography L01
or in any other productions where Priestley Sixth Form College may wish to use the material(s) for
marketing and publicity or any other use in electronic, web or paper based forms.
I understand that the material will be used solely for the promotion or benefit of the college and that it
may be released for use by external media organisations in accordance with this purpose.
I understand the material(s) will be the copyright of Priestley College and may be used as is or in
conjunction with other material(s), as part of a composite production.
I understand that I have the right to ask the College to stop using my image or photograph(s) in any
future publications. However, I acknowledge that the College cannot recall publications in which my
image has already appeared.
Signed
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Print Name
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Date
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Address
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Email:
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The personal information provided on this form will be used for the purpose of administering the use of
your images/recordings at the College only and will be processed in accordance with the Data Protection
Act 1998.