Photo and Likeness Release Form

Photo and Likeness Release Form
Authorize the use of your photo, video, or likeness by completing this release form.
Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Subject / Event Name or Project Title
Date of Photo/Video Session or Use
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Name of Photographer / Organization / Company
Describe the photos, video, or likeness usage being authorized
Signature
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Should be Empty: