Model Photo & Video Likeness Release & Usage Authorization Form
Model Full Legal Name
· · ·
Model Email Address
· · ·
Model Phone Number
· · ·
Submit
The Model Photo & Video Likeness Release & Usage Authorization Form is a legally structured template designed to obtain clear, documented consent from models before using their image or likeness in photos, videos, or other media. It captures essential model information, shoot details, and the specific formats and purposes for which the likeness may be used.
This form is ideal for photographers, videographers, production companies, marketing agencies, and content creators who need a reliable release on file. It also includes a parent or guardian section for models under 18, ensuring compliance when working with minors. Usage duration and authorized formats are clearly defined to avoid disputes down the line.
By using this free template, you can streamline your pre-shoot paperwork, protect your business legally, and give models confidence that their likeness will only be used within agreed-upon boundaries. Customize it to match your brand and start collecting signed releases digitally in minutes.
4Pages
28Questions
~9minTo complete
FreeNo credit card needed
Field types
Single Choice ×5
Short Text ×4
Full Name ×2
Email ×2
Phone ×2
Date ×2
daterange ×2
Multiple Choice ×2
Signature ×2
Address
currency
Long Text
singlecheckbox
termsandconditions
Questions in this template
Free template
The exact questions included — customize any of them to fit your needs.
Page 1Model Information9 questions
Model Information
1
Model Full Legal Name
*Full Name
2
Model Email Address
*Email
3
Model Phone Number
*Phone
4
Model Home Address
*Address
5
Date of Birth
*Date
6
Are you 18 years of age or older?
*Single Choice
Parent / Guardian Information (If Model Is Under 18)
7
Parent or Legal Guardian Full Name
Full Name
8
Parent or Legal Guardian Phone Number
Phone
9
Parent or Legal Guardian Email Address
Email
Page 2Production & Usage Details8 questions
Production Details
1
Project or Production Title
*Short Text
2
Name of Photographer / Videographer / Production Company
*Short Text
3
Shoot Date(s)
*daterange
4
Shoot Location
*Short Text
Authorized Usage
5
I authorize the use of my likeness in the following formats:
*Multiple Choice
6
I authorize the use of my likeness for the following purposes:
*Multiple Choice
7
Duration of Usage Authorization
*Single Choice
8
If limited, specify the authorized usage period
daterange
1
Do you grant the right to edit, crop, alter, or digitally modify the images or footage?
*Single Choice
2
Do you grant the right to sublicense or transfer usage rights to third parties?
*Single Choice
Compensation
3
Compensation Type
*Single Choice
4
If paid, agreed compensation amount
currency
Restrictions & Exclusions
5
Are there any specific restrictions on how your likeness may be used? (e.g., no tobacco or alcohol advertising, no political campaigns)
Long Text
Page 4Legal Acknowledgment & Signature6 questions
Legal Acknowledgment
By signing below, I acknowledge that I have read and fully understand this Model Photo & Video Likeness Release & Usage Authorization Form. I voluntarily grant the rights described herein. I release and discharge the photographer, videographer, production company, and their affiliates, successors, and assigns from any and all claims, demands, or causes of action arising out of or in connection with the use of my likeness, image, voice, or appearance, including but not limited to claims of defamation, invasion of privacy, right of publicity, or copyright infringement. I understand that this release is binding upon me, my heirs, legal representatives, and assigns.
1
I confirm that all information provided is accurate and that I have the legal authority to sign this release.
*singlecheckbox
2
I have read, understand, and agree to the terms of this Model Photo & Video Likeness Release & Usage Authorization.
*termsandconditions
Signatures
3
Model Signature (or Parent/Guardian Signature if under 18)
*Signature
4
Date of Signature
*Date
5
Witness Signature
Signature
6
Witness Printed Name
Short Text
How to use this template
Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.
Ready-to-use structure — pre-configured fields out of the box
Applied "Peach" theme — fonts, colors, and layout already set
Mobile-responsive — works on every device without extra configuration
Fully editable with drag-and-drop — change anything in seconds
Free to use on any plan, no credit card required
Use this template
Free to use. Open in the editor, customize, and publish in minutes.
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