Cosplayer Model Release Form

Photographer: Paul Jacques

Address: 192 Woodthorpe Road, Ashford, Middlesex, TW15 3LQ
Tele no or Email: paul@DigViz.com

1. Name ............................................... 2. Character: ....................................................................

3. Address ..............................................................................................................................................
.................................................................................................................................................................
4. Email ..................................................................................................................................................
Fee: None
5. When: ./......../.. Where: ...........................................................
Usage: I understand that the photographs taken of me during this session can be used wholly or in
part in Magazines, Books, Calendars, Internet, Portfolios, Exhibition, Editorial or Advertising use. The
photographs taken may be used to represent an imaginary person and any wording associated will
not be attributed to me personally unless my name is used. Use of the photographs may be sold,
granted or transferred to third parties at the discretion of the photographer named above.
Terms: By signing this form I acknowledge that I am subject to restrictions stipulated and relinquish
all claims of ownership, income, editorial control and use of the resulting photographs and assign all
copyright ownership to the photographer and no further payment will be due.
I have read this form carefully and fully understand its meanings and implications. I acknowledge that
by signing this form I give Paul Jacques full and unreserved copyright and authority to publish the
photographs and agree with the terms and usage listed above.

Yes

6. Signed ........................................................... 7. Date /../. 8. I am 18+ No*

*If you are under 18 year of age, a parent or legal guardian must also sign below:

Parent/ Guardian signed ......................................................................... Date /......./.

contact details if different from above ......................................................................................................
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Official Use, please leave: