Adapt this model release to use with your patients. (This is not legal advice. If you are uncertain, consult with legal professionals.) Do not violate rules and regulations in your jurisdiction.
Model Release And Authorisation To Photograph And Video
I hereby grant the undersigned photographer ("Photographer") the irrevocable right and permission, throughout the world, in connection with the photographs and videos he/she has taken of me, or in which I may be included with others, the following: (a) the right to use and reuse, in any manner at all, said photographs and/or videos, in whole or in part, modified or altered, either by themselves or in conjunction with other photographs and/or videos, in any medium or form of distribution, and for any purposes whatsoever, including, without limitation, all promotional and advertising uses, and other trade purposes, as well as using my name in connection therewith, if he so desires; and (b) the right to copyright said photographs and/or videos in his own name or in any other name that he may select. I waive the right to inspect or approve any use thereof.
I hereby forever release and discharge Photographer from any and all claims, actions and demands arising out of or in connection with the use of said photographs and videos, including, without limitation, any and all claims for invasion of privacy and libel. This release shall inure to the benefit of the assigns, licensees and legal representatives of
Photographer, as well as the party(ies) for whom he took said photographs.
Please check:
______ I represent that I am over the age of eighteen years and that I have read the foregoing and fully and completely understand the contents hereof.
Date:_______________
__________________________________________ (Model's Signature)
___________________________________________ (Model's Name)
Phone: __________________
Address: ___________________________________________