Model Release Form

PHOTOGRAPHER: ___David Scrivener_______________________________________________

MODEL:               _____________________________________________________________________

MODEL’S EMAIL ADDRESS:   ____________________________________________________________

MODEL’S MAILING ADDRESS: ___________________________________________________________

IN CONSIDERATION OF HAVING RECEIVED  ___Print and 10 jpg images____________________

IN RETURN FOR POSING FOR PHOTOGRAPHS TAKEN ON (date):  ________________________________

AT (location):                     _____________________________________________________________


I hereby assign full copyright of these photographs to the above-mentioned photographer (and the related representatives and assigns) together with the right of reproduction either wholly or in part. The intention of this portrait session is to build a portfolio of images for reproduction on this photographers web site, inclusion in any photographic competition and publication there after and for inclusion in any publication by the photographer.

I grant to the Photographer or assignees the permission to the above-mentioned photographs either separately or together, either wholly or in part, the perpetual and  irrevocable and unrestricted right to use and publish photographs of me, or where I may be included.

The Photographer and licensees or assignees may have unrestricted use of these for whatever purpose, including advertising, with any retouching or alteration without restriction.  The images are NOT intended for product advertising and such other fashion /business purpose in any manner or medium.

 I undertake not to Prosecute or to institute proceedings, claims or demands against either the Photographer or his or her agents in respect of any usage of the above mentioned photographs. I hereby release the photographer named above from all claims and liability relating to images or photographs taken of me.

I have read this model release form carefully and fully understand its meanings and implications.


signed: _______________________________    date: __________


Important:  If the Model is under 18 year of age, a parent or legal guardian must also sign

parent/guardian: _______________________    date: __________