This is a document that is used by a company to obtain a release from another party
when using that party’s photograph or video. By signing this document, the party gives
the company permission to use his or her image perpetually during the exhibition or
display of a project. In addition, the party releases the company from any claim for
compensation. This document should be used by individuals or entities in connection
with a project to obtain a release from an individual to use that individual’s photograph
Photograph & Video Release Form
For good and valuable consideration I irrevocably grant to ______________ [Instruction: insert the
name of the individual or company that is seeking the release] permission, all rights to, in and of my
name, image, likeness, sound of my voice as recorded, publicity and biographical information (the
“Materials”) and any of the associated works of authorship (including written materials or transcripts of
what I say) used in or with my recording (the “Written Materials”) on any medium in perpetuity,
throughout the universe and for any purpose related to the business of ______________ [Instruction:
insert the name of the individual or company that is seeking the release], all royalty free. I
irrevocably grant to ______________ [Instruction: insert the name of the individual or company that
is seeking the release] the rights to copyright, edit, use, modify, copy, exhibit, display, publicly perform,
publish, broadcast, print, reprint, create derivative works from, distribute, and sell the Materials and the
Written Materials in their entirety or in any portion, in any form or medium that now exists or may exist
in the future, individually or in conjunction with other works or as a collective work, in print, audio,
video, electronic, or digital form, including but not limited to the exercise of such rights through Internet
or Intranet sites, computer on-line services, and all other electronic and non-electronic media and
distribution mechanisms now known or later developed.
I waive any right of notice, inspection or approval of the uses of the Materials or the Written Materials,
including for advertising, marketing, promotional, testimonial or other uses. Additionally, I waive any
right to royalties or other compensation arising from or related to the use of The Materials or Written
Materials. I also understand that the Materials and Written Materials may be used in diverse settings
within an unrestricted geographic area.
I warrant that I am the sole owner of, or have obtained a license for, all rights in the Written Materials,
that the Written Materials do not infringe the copyright or other property rights of any third party, and that
I have full power to convey the rights granted in this Agreement.
I release and discharge ______________ [Instruction: insert the name of the individual or company
that is seeking the release], including without limitation its officers, employees, agents, and
representatives, from any and all claims, demands, and causes of action that I may have against it by use
of the Materials or the Written Materials, including without limitation any claims based on the right of
privacy, the right of publicity, copyright, libel, or slander.
I grant to ______________ [Instruction: insert the name of the individual or company that is seeking
the release] the right to assign or license to third parties any of the rights contained herein.
By signing this document I acknowledge that I have completely read and fully understand the above
release and agree to be bound thereby. I am 18 years of age or older as of the date hereof, or this
document bears the signature of my parent or legal guardian,
State & Zip Code_____________________________________________________________
Phone(s)______________ ___________________________ Fax _______________________
© Copyright 2013 Docstoc Inc. registered document proprietary, copy not 2
If this release is obtained from a person under the age of 19, then the signature of that person’s parent or
legal guardian is also required.
Parent’s Signature_____________________________ Date____________________________
© Copyright 2013 Docstoc Inc. registered document proprietary, copy not 3