MODEL RELEASE FORM
THIS FORM MUST BE SIGNED BEFORE ANYPHOTOGRAPHY IS UNDERTAKEN
Name of Photographer: TobyChurchill
Job:Photographer
Name of Client:Filmfour
Descriptionof Photography: longshots,wideshot
Date of shoot:23 3 22
I permit the photographernamed above and his/her licensees or assignees to use the photograph(s)and/or
drawingstherefrom and any otherreproductions or adaptations therefromeither complete or in part alone or in
conjunction with any wording and/ordrawings for all uses including publicity and/or merchandising and/or
editorial purposesin any country. Unless otherwise agreed the photograph(s) and any drawings or adaptations
thereof shall be deemed to represent an imaginary person. No changes to the terms of this model release are
accepted unlessagreed in writing by the photographer,his/her assignees or licensees or myself.
I understand that I do not have any interest in the copyright to the photograph(s) nor shall I receive any further
payment.
I am over 18 years old. (Modelswho are under 18 years of age must provide evidence of consent by a parent or
guardian to this model release.)
Name of Model : Jessica
Addressof Model: 87 midanburylane
Contact numberof Model : 073732754
Signature of Model: Date: 3 3 22
Signature of Parentor Guardian: Date: 3 3 22
(if model under 18)

MODEL RELEASE FORM.docx

  • 1.
    MODEL RELEASE FORM THISFORM MUST BE SIGNED BEFORE ANYPHOTOGRAPHY IS UNDERTAKEN Name of Photographer: TobyChurchill Job:Photographer Name of Client:Filmfour Descriptionof Photography: longshots,wideshot Date of shoot:23 3 22 I permit the photographernamed above and his/her licensees or assignees to use the photograph(s)and/or drawingstherefrom and any otherreproductions or adaptations therefromeither complete or in part alone or in conjunction with any wording and/ordrawings for all uses including publicity and/or merchandising and/or editorial purposesin any country. Unless otherwise agreed the photograph(s) and any drawings or adaptations thereof shall be deemed to represent an imaginary person. No changes to the terms of this model release are accepted unlessagreed in writing by the photographer,his/her assignees or licensees or myself. I understand that I do not have any interest in the copyright to the photograph(s) nor shall I receive any further payment. I am over 18 years old. (Modelswho are under 18 years of age must provide evidence of consent by a parent or guardian to this model release.) Name of Model : Jessica Addressof Model: 87 midanburylane Contact numberof Model : 073732754 Signature of Model: Date: 3 3 22 Signature of Parentor Guardian: Date: 3 3 22 (if model under 18)