Model Release Form - Template, Sample Form to Complete

MODEL RELEASE FORM

(Province of ________)

This Model Release Form (the "Release") is made and entered into as of ________ in respect of the use of personal media and images created for an artistic or commercial endeavour between the following parties:

§ 1. Parties

(a) ________, a photographer (the "Photographer"), with an address at:

________

and

(b) ________ (the "Model"), with an address at:

________

§ 2. Grant of Authorization

(a) I, ________, in consideration of the sum of ________ and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, hereby absolutely and irrevocably authorize the Photographer, together with the Photographer's legal representatives, licensees, assignees and transferees, to use, reproduce, publish, reuse, republish, distribute, disseminate, exhibit, modify and otherwise make publicly available, for any artistic or commercial purpose (including advertising, promotion, publication and illustration), the images of me and/or my property described below.

(b) Description of the images and/or property (the "Images"):

________

(c) The Images were or are to be taken on ________, at ________.

(d) The authorization granted under this § 2 applies in whole or in part, whether individually or collectively with any other material, in any and all forms of media now known or hereafter developed, including, without limitation, print media, digital media, the Internet, composite images and altered or distorted images, or for any other lawful use as the Photographer may determine in the Photographer's sole and exclusive discretion, including the use of my name without restriction. The Photographer may use fictitious names in conjunction with the Images.

§ 3. Release and Waiver

(a) I hereby fully and completely release, waive and forever discharge the Photographer and the Photographer's legal representatives, licensees, assignees and transferees from any and all demands, actions, causes of action, liabilities, losses, damages and claims of any kind whatsoever that may arise out of or be connected with the use of the Images featuring me, my likeness, my name or my property, including, without limitation, any and all claims for misappropriation of personality, violation of any right of publicity or right of privacy, defamation (including libel and slander), or any breach of moral rights.

(b) To the extent permitted by law, I waive any and all rights to inspect, approve or otherwise review the finished Images or any use to which they may be put, and I waive any claim arising from any alteration, distortion, optical illusion or use in composite form, whether intentional or otherwise.

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§ 4. Consent Under Privacy Legislation

I consent to the collection, use and disclosure of my personal information (including my image, likeness and name) by the Photographer for the purposes set out in this Release, in accordance with the Personal Information Protection and Electronic Documents Act (Canada) and any applicable provincial privacy legislation in force in the Province of ________.

§ 5. Excluded Uses

Notwithstanding the foregoing, the following uses of the Images are specifically excluded and are not authorized by this Release:

________

§ 6. Capacity and Acknowledgment

I represent and warrant that I am a legally competent adult, of the full age of majority in the Province of ________, and that I have the legal right and capacity to contract in my own name. I confirm that I have read this Release in its entirety, that I understand its contents in full, and that I have had the opportunity to seek independent legal advice before signing.

§ 7. Successors and Assigns

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§ 8. Entire Agreement and Severability

(a) This Release constitutes the entire agreement between the parties with respect to its subject matter and supersedes all prior negotiations, understandings and agreements, whether written or oral.

(b) If any provision of this Release is held to be invalid, illegal or unenforceable, that provision shall be severed and the remaining provisions shall continue in full force and effect.

§ 9. Governing Law and Jurisdiction

The Model agrees that this Release shall be governed by and construed in accordance with the laws of the Province of ________ and the laws of Canada applicable therein. The parties irrevocably submit to the exclusive jurisdiction of the courts of the Province of ________, and to any other court having jurisdiction over a party solely to enforce a judgment of a court of that Province. Neither party shall seek to enforce an order originating in any court other than the courts of the Province of ________.

IN WITNESS WHEREOF, the parties have executed this Model Release Form as of the date first set forth below.

PHOTOGRAPHER

Signature: ___________________________________

Print Name: ________

Date: ________

MODEL

Signature: ___________________________________

Print Name: ________

Date: ________

WITNESS

Signature: ___________________________________

Print Name: ________

Address: ________

Date: ________