model release form

MCKIE RICH Productions requires that all persons appearing on camera must fill out the below form.

First, Last Name

Email Address

Phone

Address

Date of Birth

Social Media Handle

I, applicant model, hereby grant permission to MCKIE RICH Productions, the rights of my image, in video or still, and of the likeness and sound of my voice as recorded on audio or video tape. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area. Photographic, audio or video recordings may be used for ANY USE which may include but is not limited to: • Presentations; • Courses; • Online/Internet Videos; • Media; • News (Press); By signing this release, I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet or in the public educational setting. I will be consulted about the use of the photographs or video recording for any purpose other than those listed above. There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed. This release applies to photographic, audio or video recordings collected as part of the sessions listed on this document only.By signing this release, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes. I affirm that I am 18 years of age or older, and competent to sign this release on my own behalf. I have read this release and fully understand its implications. I declare that the info I’ve provided is accurate & complete.

Release by Parent/Guardian of Minor Child I am the parent or legal guardian of the minor above named, and has legal authority to execute this release on his/her behalf. I have read and fully understood the contents of this release, and consent to the use of said photograph based on the contents of this release.

Parents Contact Information

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