Photo and Video Release Form
Photographers Information
Full Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Age
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Would you like to reveal your identity for the purpose of promotion?
Yes
No
Model Information
Full Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Age
Full Name of Parent of Guardian (if model is 18 years or younger)
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Upload a photo of your subject to identify them
Event/Activity Date
-
Month
-
Day
Year
Date
Name of Activity
Location of the Event/Activity
Back
Next
Authorisation and Release Agreement
I understand that this photograph has been taken for project specific purposes and could be published online, in print and publicly.
I understand that I will/ will not receive any monetary compensation.
I authorise Perth Centre for Photography to distribute and reproduce the materials for the following purposes: Portfolio showcase, advertising, marketing, branding, educational, digital promotions, internet videos, online courses, media, other commercial or non-commercial purposes
I grant Perth Centre for Photography to use my photos and videos on Youtube, Vimeo, Facebook, Twitter, Instagram, and other social media platform.
I do not permit Perth Centre for Photography to use these materials that can harm my reputation or others.
I release Perth Centre for Photography from all liability and obligations from any claim for injury, illnesses, claims, or demands.
I, the undersigned, hereby agreed that we have read this agreement and bounded by it.
Client Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
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