Model Release Form

MODEL RELEASE FORM - 2024

Tilly Nelson | +1 (236) 818-7225

tilly@tillynelson.com | www.tillynelson.com

Photographer Name : Tilly Nelson

Model Name:*

First NameLast Name

Model Address:*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Model Contact Number:*

As I work internationally, please include your country Code

Email Address:*

example@example.com

Model Agency - if represented:

Please include name of agent, email address and phone number

Date of Shoot:*

Note this HAS to be the date of the shoot otherwise it doesn't cover the images.

Shoot Description:

E.g: Headshots

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 the absolute right to use the photograph(s) and video and any other reproductions or adaptions, from the above mentioned photographic shoot in the uses stated below;

Media Use:

Artist reference, Brochure, Catalogue, Collateral (business cards, comp slips, letterheads, cards), Competitions, Direct mail, EDM (electronic direct mail), Inserts, Magazine (trade and consumer,) Mobile devices, National press, Online, Packaging Point-of-Sale & Point-of-Purchase, PR, Poster, Social media, Self Promotion, Test/portfolio use, Web (all), Web Banners.

Territory: Worldwide Time Period: Ongoing

Yes I grant permission to the photographer to use images of specified talent for the above outlined use.

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.

I agree that I have no rights to make any further money from the Photograph(s) & Video 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

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

Date of Birth

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

First NameLast NameRelation to child

By signing I agree to the above terms and conditions

Signature: *

Date Signed:*

Date