Fillable Printable Sample Photo Release Form

Sample Photo Release Form

This is a typical release form used to secure permission to use an individual’s likeness with or without identification.

From Public Relations Writing & Media Techniques (Fourth Edition) by Dennis Wilcox.

Sample Photo Release Form

Organization Name

Address

City, State, Zip

Permission to Use Photograph

Subject: ____________________

Location: ___________________

I grant to [insert organization], its representatives and employees the

right to take photographs of me and my property in connection with

the above-identified subject. I authorize [insert organization], its

assigns and transferees to copyright, use and publish the same in print

and/or electronically.

I agree that [insert organization] may use such photographs of me

with or without my name and for any lawful purpose, including for

example such purposes as publicity, illustration, advertising, and Web

content.

I have read and understand the above:

Signature _________________________________

Printed name ______________________________

Organization Name (if applicable) __________________________

Address __________________________________

Date _____________________________________

Signature, parent or guardian _______________________

(if under age 18)