Media Release Form

Type of Release

What type of release is this?

For a specific person: I will enter the Model / Actor / Subject's name now.General: leave a blank space where a name can be written in later.

(Photographer, Videographer, Production Company, etc.)

First and Last Name (or Company Name)

(Model, Actor, Subject, Performer, etc.)

First and Last Name

This is the person being photographed or recorded.

This person is a/an

AdultMinor

Name of the Minor's Parent or Legal Guardian

• Digital and Analog Photographs

• Film and Video (with or without sound)

• Audio Recordings

• Other Forms of Media/Art

• Advertising

• Artwork

• Trade

• Promotional Materials

• Streaming

• TV and/or Film

• Any Other Works or Materials

This release is made under the laws of which state?

Typically the state where the Releasee (Photographer, Producer, etc.) lives or works.

Would you like to include any other terms or conditions?

YesNo

Additional Terms and Conditions