Headshot Model Release Form

MODEL RELEASE FORM - 2026

Photographer Name : Tilly Nelson | +1 (236) 818-7225

tilly@tillynelson.com | www.tillynelson.com

Model Name:*

First NameLast Name

Date of Birth of model if under 18 years of age:

Date of Birth

Model Address:*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Model / Parent /Guardian Contact Number:*

Email Address:*

example@example.com

Model Agency - if represented:

Date of Shoot:*

Date

In accepting this release it is the responsibility of the Photographer not to use or authorise the use of the material except for the uses stated below. Further usage must be negotiated and agreed beforehand, in writing, with the model/ model agency. I hereby grant the Photographer and the team involved in the shoot (Wardrobe Stylists, Prop Stylists, Hair and Make Up Artist, Producer) the absolute right to use the photograph(s) and any other reproductions or adaptions, from the above mentioned photographic shoot in the uses stated below;

Media Use: Website, Social media, Promotional materials to advertise Tilly Nelson as a photographer, Photography Competitions and Exhibitions, Magazine submissions.

Territory: Worldwide Time Period: Ongoing

If you would like to request a specific restriction on useage, this must be discussed and put in writing at the time of signing form.

*

Yes I grant permission to the photographer to use images of specified talent for the above outlined use.No, I do not grant permission to the photographer to use images of specified talent for the above outlined use.

I agree that I have no rights to distribute or make any further money from the Photograph(s) and that I will make no further claim for any reason to Photographer. I agree that all rights belong to the Photographer. I acknowledge and agree that this release is binding upon my heirs and assigns. I agree that this release is irrevocable, worldwide and perpetual.

*

I, the model, am over 18 years of age*I am signing as a Parent/ Guardian on behalf of model under 18 years of age

*

By signing I agree to the above terms and conditions

Signature: *

*If signed by Parent/ Guardian or Model Agency, please insert full name of signee:

First NameLast NameRelation to child

Date Signed:*

Date