Model Release Form

Creating Lasting Memories Through Beautiful Photography.

Adult model release for use of likeness and imagery.

BTL-PBL-04.003

Form

Vol 04 — Legal, Risk & Compliance

Model

Model full legal name *

Address *

Email *

Phone

Date of birth *

Shoot date *

Shoot location *

Description of imagery *

Compensation (if any)

Permitted uses (marketing, editorial, portfolio, commercial) *

Exclusions / restrictions

Territory & duration

Model signature *

Date *

Witness signature

Date

Prepared by

Name · Title · Date

Reviewed by

Name · Title · Date

Approved by

Owner · Katheryn L. Wilkins · Date

Controlled document — BTL-PBL-04.003. Complete all required fields (marked *). Retain per Volume 15 retention schedule.