Model Release Form - Template, Sample Form to Fill out

MODEL RELEASE

THIS MODEL RELEASE (hereinafter the "Release") is made on ________.

PARTIES

PUBLISHER (hereinafter the "Publisher"):

Publisher name: ________

ABN/ACN: ________

Publisher address:

________

MODEL (hereinafter the "Model"):

Model name: ________

Date of birth: ________

Model address:

________

1. BACKGROUND

1.1 The Publisher and the Model have agreed for the Publisher to produce photographs and/or other recorded images of the Model (the "Work").

1.2 The Model consents to the Publisher using the Model's image in order to produce the Work, and the Model acknowledges that all right, title and interest in the Work will be the property of the Publisher, on the terms set out in this Release.

1.3 The Publisher agrees to produce the Work in consideration for the Model's agreement to be bound by the terms of this Release. In consideration of the mutual benefits and obligations set out in this Release (and the payment, if any, set out in clause 3), the Publisher and the Model agree as follows.

2. CONSENT, ACKNOWLEDGEMENT AND RELEASE

By signing this Release, the Model hereby:

2.1 consents and agrees to the Publisher, together with any officers, employees, directors, agents, contractors, assignees, licensees, transferees, successors, legal representatives or other representatives of the Publisher (the "Publisher's Representatives"), photographing the Model and using, reproducing, publishing, broadcasting, exhibiting, distributing and otherwise exploiting any image(s) of the Model and any derivative works in any medium now known or later developed, anywhere in the world, in any way the Publisher or any of the Publisher's Representatives determine in their absolute discretion;

2.2 consents to the publication of the Model's name together with the Work;

2.3 consents to the use of fictitious names together with the Work;

2.4 acknowledges and agrees that all right, title and interest (including copyright under the Copyright Act 1968 (Cth)) in or relating to any Work belongs to the Publisher absolutely, and to the extent any such right vests in the Model, the Model assigns it to the Publisher;

2.5 consents, for the purposes of section 195AW and Part IX of the Copyright Act 1968 (Cth), to any act or omission by the Publisher or the Publisher's Representatives that would otherwise infringe the Model's moral rights (if any) in the Work, and irrevocably waives such moral rights to the fullest extent permitted by law;

2.6 consents, for the purposes of the Privacy Act 1988 (Cth) and any applicable State or Territory privacy legislation, to the Publisher collecting, holding, using and disclosing the Model's personal information and image in connection with the Work and the matters contemplated by this Release; and

2.7 irrevocably and unconditionally releases and discharges the Publisher, together with any of the Publisher's Representatives, from any and all claims, debts, demands, suits, actions, proceedings or other liabilities whatsoever (including any costs whether legal or otherwise) which the Model may have at any time arising in connection with the Publisher's use of the Work, including any claim for defamation, breach of privacy, or passing off.

3. CONSIDERATION

3.1 In consideration for the rights and consents granted under this Release, the Publisher shall pay the Model the sum of ________ (inclusive of GST, where applicable), payable on ________.

3.2 The Model acknowledges that the consideration referred to in clause 3.1 (or, where no monetary amount is stated, the mutual promises in this Release) constitutes full and final consideration for all rights granted and is in lieu of any further payment, royalty or remuneration.

4. WORK

The Work to which this Release relates specifically includes the following:

________

5. WARRANTIES AND CONFIRMATION

The Model hereby confirms, warrants and represents that:

5.1 the Model is over the age of eighteen (18) years and has the legal capacity and right to enter into this Release in the Model's own name;

5.2 the Model has had the opportunity to obtain independent legal advice and has read this Release in full prior to signing it;

5.3 the Model fully understands the contents and effect of this Release;

5.4 the Model is not under any contractual or other restriction or obligation that is inconsistent with the execution and performance of this Release; and

5.5 the Model intends for this Release to be binding on the Model, together with the Model's heirs, executors, administrators, assigns and legal representatives.

6. GENERAL

6.1 Entire agreement. This Release constitutes the entire agreement between the Publisher and the Model in relation to its subject matter and supersedes all prior negotiations, representations, understandings and agreements, whether oral or written, between the parties.

6.2 Variation. No variation or amendment of this Release shall be effective unless made in writing and signed by or on behalf of both the Publisher and the Model.

6.3 Severance. If any provision of this Release is found to be invalid, illegal or unenforceable, that provision shall be severed and the remaining provisions shall continue in full force and effect.

6.4 Assignment. The Publisher may assign, novate or otherwise deal with its rights under this Release. The Model may not assign its obligations without the prior written consent of the Publisher.

6.5 Counterparts. This Release may be executed in any number of counterparts, each of which when executed and delivered constitutes an original, and all counterparts together constitute one instrument.

7. GOVERNING LAW AND JURISDICTION

7.1 This Release shall be governed by and construed in accordance with the laws of ________ and the applicable federal laws of the Commonwealth of Australia.

7.2 The parties irrevocably submit to the non-exclusive jurisdiction of the courts of ________ and the courts competent to hear appeals from those courts.

EXECUTED AS AN AGREEMENT

Executed by ________ in accordance with section 127 of the Corporations Act 2001 (Cth) by:

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Signature of director

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Name of director

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Date

Signed by the Model ________ in the presence of:

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Signature of Model

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Date

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Signature of witness

________
Name of witness

________
Address of witness