Model Release Form

AUSTRALIAN INSTITUTE OF PROFESSIONAL PHOTOGRAPHY LTD A.C.N. 050 167 498 A.B.N. 77 050 167 498
AIPP NATIONAL OFFICE: PO BOX 372, NORTH MELBOURNE VICTORIA, 3051 TEL: 1800 686 696 FAX: (03) 9329 9933
THIS FORM MUST BE SIGNED BEFORE ANY PHOTOGRAPHY IS UNDERTAKEN
______________________________________________________________________
Name of Photographer…………………………………….. Job /Series No…………………
Name of Advertising Agency
Or Client (if assignment)…………………………………… Order No. ………………………
Description of Date of
Photography………………………………………………… Photography …………………..
______________________________________________________________________
I permit the photographer named above and his/her licensees or assignees to use the photograph(s)and/or drawings therefrom and any other reproductions or adaptations therefrom either complete or in part alone or in conjunction with any wording and/or drawings for all uses including publicity and/or merchandising and/or editorial purposes in 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 unless agreed 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. (Models who are under 18 years of age must provide evidence of consent by a parent or guardian to this model release.)
Name of Model Agency (if any)
……………………………………………………………………………………..…………
Name of Model (capital letters)
…………………………………………………………………….………………………….
Address of Model
…………………………………………………………………………………………..……
Signature of Model ……………………………………………………Date …………………
Signature of Parent or Guardian …………………………………… Date …………………
(if model under 18)
Witness ……………………………………………………………….…Date …………………
This is a basic Model Release. The AIPP suggests you follow your solicitor's advice for your specific requirements.

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Model Release

In consideration of my engagement as a model, upon the terms herewith stated, I hereby give to _____________________________ [photographer] his/her heirs, legal representatives and assigns, those for whom the photographer is acting, and those acting with his/her authority and permission:

a) the unrestricted right and permission to copyright and use, re-use, publish, and republish photographic portraits or pictures of me or in which I 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 own or a 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.

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

c) I hereby relinquish any right that I 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.

d) I hereby release, discharge and agree to save harmless [photographer], his/her heirs, legal representatives or assigns, and all persons functioning under his/her permission or authority, or those for whom 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.

e) 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.

Print Name: _________________________________

Signed:______________________________________

Dated: ______________________________________

Address:_____________________________________

City:________________________________________

State/Zip:____________________________________

Phone:______________________________________

Email: ______________________________________