Illinois Model Release Form

Transcript

Model Release 4-H Photograph or Video Exhibits This form is for use by 4-H Photography/Video members and exhibitors who have included other individuals in the photographs/videos they have on display. Date 4-H Photographer/Videographer Address City/State/Zip Phone / For valuable consideration, I hereby irrevocably consent to and authorize the use and reproduction by you, or anyone authorized by you, of any and all photographs/videos which you have this day taken for any purpose whatsoever, without further compensation to me. All negatives and positives, together with the prints or all videotapes or electronic video recordings shall constitute your property, solely and completely. I am 18 years of age or older. Yes No Model’s Name (print) Model’s Signature Address City/State/Zip Witnessed by: Signature of Witness If the model signing is under 18 years of age, consent must be given by parent or guardian: I hereby certify that I am the parent or guardian of (the model named above), and for value received I do give my consent without reservations to the foregoing on behalf of him or her. Signature of Parent/Guardian Date Witnessed by: Signature of Witness Revised 2/2011