Sample Photo Release Form
Name of Storyteller: _________________________________________________________________________
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)
Name of Storyteller: _________________________________________________________________________
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)