Canadian Photo/Video Consent Agreement
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PDF Photo/Video Consent Agreement Form

This agreement is used by a model/subject (or the parent/guardian, if the subject is a child) to consent to the use of their image and/or sound in photographic, motion picture, or audio recordings. Furthermore, the agreement specifies the theme, location, schedule, and use of the recordings.

More about Photo/Video Consent Agreement legal forms.

  • Proceed through this form, providing as much information as possible.
  • Do not use the '&' (ampersand) and '"' (double-quotation mark) characters.
  • When you are done, click on 'Build Document' at the bottom.

Nature of Consent:

Are you filling out this consent on behalf of a child in your care?
 Yes No

Guardian's Information:

Model's Information:

Name:

Address:

City:

Country:

State:

Province:

Zip Code:

Phone (e.g. (206) 693-6954):

Child's Information:

Full Name (e.g. Anne Mary Jones):

Photographer/Recorder's Information:

Name:

Do you wish to list this person's company?
 Yes No

Company:

Type of Materials:

Select all that are applicable:

Film Photographs
 Yes No

Digital Photographs
 Yes No

Motion Picture Footage
 Yes No

Audio Recordings
 Yes No

Theme of Materials:

Examples of themes could be glamour modelling, promotion of a product, travel photos, filming of a commercial, art exhibition, etc.
Please describe the theme(s) of the materials:


Location:

Examples of locations could be 123 Oak St., Ridgewood Elementary School, downtown Toronto, etc.
At what location(s) will the photography/recordings occur:


Schedule:

Examples: 11:00am on June 1st, 2007, May 14th-30th, 2009, December 2007, etc.
What is the approximate date(s) of the photography/recordings?


Additional Provisions:

Do you wish to add other details or conditions?
 Yes No

Number of provision to add:

First provision:


Second provision:


Third provision:


Fourth provision:


Fifth provision:


Date of Signing:

You can leave these fields blank if you do not know the date.
Day:

Month:

Year: