Model Release Form printable pdf download

Model Release Form

Dig no. ______________

Job no. ________________

MR no. ____________________

Model Release Form

Stills photography/film

In signing this deed I irrevocably:

Consent to the University, its employees or agents photographing/filming me and using any image

of me as the University thinks fit in its absolute discretion to promote the University or any of the

University’s activities.

Acknowledge that all right, title and interest in or relating to any image of me taken by or on behalf

of the University belongs to the University absolutely for its own use.

Release the University from any claim by me, or on my behalf, arising out of the University’s use of

any photograph/video of me.

Released by:

Full name:

Address:

State:

Postcode:

Telephone:

Mobile:

Email address:

DOB (Optional):

(the subject/legal guardian) in favour of: Griffith University, a body corporate pursuant to the Griffith University Act

1998, of Kessels Road, Nathan, Qld (the University)

Executed as a Deed

SIGNATURE:

__________________________________________________

Witness’ signature

Witness’ name (please print)

Date:

Complete this box only if the subject is under the age of 18 years.

As ________________________________ (insert subject’s name and student number) is under

the age of legal consent, in respect to his/her/their appearance in still photography produced by

Griffith University, I hereby acknowledge and agree to the above statements by signing this deed on

their behalf.

OFFICE USE ONLY

GRIFFITH PROMOTION & ADVERTISING

Purpose:

Location:

Photographer:

01/05/2008

Model Release Form