Model release form

The document below is commonly used in the media to enable

people to gain permission to use them in any of the following:
filming, photographic and sound recording. In my case the model
release form is regarding photographic terms and for this process
the model that I am using (Jackalyn West) had to fill out the form
with her relevant information.

Filming, Photographic and Sound Recording Release Form

I hereby give xxxxxxxxx the right to use (delete as appropriate)
video recording(s)
sound recording(s)
photograph(s)
of myself.
Taken
on/between: .................................................................................................................
......................
for use
in: ................................................................................................................................
.......................
or in any other productions where Priestley Sixth Form College may wish to use the
material(s) for
marketing and publicity or any other use in electronic, web or paper based forms.
I understand that the material will be used solely for the promotion or benefit of the
college and that it
may be released for use by external media organisations in accordance with this
purpose.
I understand the material(s) will be the copyright of Priestley College and may be
used as is or in conjunction with other material(s), as part of a composite
production.
I understand that I have the right to ask the College to stop using my image or
photograph(s) in any future publications. However, I acknowledge that the College
cannot recall publications in which my image has already appeared.
Signed
....................................................................................................
Print Name
....................................................................................................
Date
....................................................................................................
Address
.....................................................................................................................................
...................................
.....................................................................................................................................
...................................

Email:
.....................................................................................................................................
...................................
The personal information provided on this form will be used for the purpose of
administering the use of your images/recordings at the College only and will be
processed in accordance with the Data Protection Act 1998.