This Photograph and Video Release Form is a legal release granting permission to use
a photograph or video containing an individual's image, likeness or voice. By executing
this document, the individual releases and discharges the company using the
photograph or video from any and all claims that may arise from the usage. This is a
standard release form that may be customized to fit the specific needs of the contracting
parties. This document should be used by companies or individuals wishing to use a
photograph or video of another person.
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
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.
© Copyright 2013 Docstoc Inc. registered document proprietary, copy not 2
State & Zip Code_____________________________________________________________
Phone(s) ______________ ___________________________ Fax _______________________
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____________________________
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