Photo/Video Consent Agreement template free sample

Sample
Photo/Video Consent Agreement

USA Photo/Video Consent Agreement


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USA Photo/Video Consent Agreement

[What is a Photo/Video Consent Agreement?]

Simply answer the questions below to personalize your Photo/Video Consent Agreement

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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.

This document is accurate and up to date! It was last reviewed by a lawyer in February 2012.


... or customize one below.


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: