• Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Model Information

  • Photographer Name

  • Model Name

  • Model Address

  • Model Phone Number

  • Model Email

Release Details

  • In consideration of my or my minor's engagement as a model, upon the terms herewith stated stated, I hereby give to the aforementioned photographer, his/her heirs, legal representatives and assigns, those for whom the photographer is acting, and those acting with his/her permission the absolute and irrevocable right and permission with respect to the photographs that he/she has taken of the aforementioned model:

  • To copyright and use, re-use, publish, and republish photographic portraits or pictures of me or my minor in which I or my minor may be included intact or in part, composite or distorted in character or form, without restriction as to changes or transformations in conjunction with my or my minor's own or fictitious name, or reproduction hereof in color or otherwise, made through any and all media now or hereafter known for illustration, art, promotion, advertising, trade, or any other purpose whatsoever.

  • I also permit the use of any printed material in connection therewith.

  • I hereby relinquish any right that I or my minor may have to examine or approve the completed product or products or the advertising copy or printed matter that may be used in conjunction therewith or the use to which it may be applied.

  • I hereby release, discharge and agree to save harmless the aforementioned photographer, his/her heirs, legal representatives or assigns, and all persons functioning under his/her permission or authority, or those for whose he/she is functioning, from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form whether intentional or otherwise, that may occur or be produced in the taking of said picture or in any subsequent processing thereof, as well as any publication thereof, including without limitation any claims for libel or invasion of privacy.

Consent for Legal Adult

  • I hereby affirm that I am over the age of majority and have the right to contract in my own name. I have read the above authorization, release and agreement, prior to its execution; I fully understand the contents thereof. This agreement shall be binding upon me and my heirs, legal representatives and assigns.

Consent for Minor

  • I have read the foregoing and fully understand the contents hereof. I represent that I am the parent/guardian of the above named model. I hereby consent to the foregoing on his/her behalf.

Date and Signature

  • Select date

  • Model or Parent/Guardian

  • Photographer

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.