Photo and Video Release Form
Client Information
Full Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Example Video
Would you like to reveal your identity?
Yes
No
Are you going to receive a compensation for the usage of your photos and videos?
Yes
No
Company Production Details
Company Name
Contact Person
First Name
Last Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Event/Activity Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of the Event/Activity
Location of Event/Activity
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Photographer's Name
First Name
Last Name
Videographer's Name
First Name
Last Name
Back
Next
Authorization and Release Agreement
I allow {companyName} to take or capture my photos and videos.
I understand that all photos and videos that will be taken in this activity are copyrighted by {companyName}.
I understand that I will/ will not receive any monetary compensation.
I authorize {companyName} 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 {companyName} to use my photos and videos on Youtube, Vimeo, Facebook, Twitter, Instagram, and other social media platform.
I do not permit {companyName} to use these materials that can harm my reputation or others.
I understand that the materials taken on this event will be covered with this document only.
I release {companyName} from all liability and obligations from any claim for injury, illnesses, claims, or demands.
I/We, the undersigned, hereby agreed that we have read this agreement and bounded by it.
Client Signature
Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: