Model Release Form Page


Please Note: You may print this information directly from this page or click here to download a pdf form.

Abilene Christian University Pruett Gerontology Center “Images of Aging” Photo Contest


I hereby give permission to _____________________________ to use my name and record my photographic likeness as a submission for the Pruett Gerontology Center “Images of Aging” Photo Contest. 

I understand that upon submission by the photographer, the Pruett Gerontology Center may make unlimited use of the photograph, including but not limited to publications or distribution by means of a print publication, the Internet, videotape, DVD, broadcast, podcast, cablecast, film or any similar electronic or mechanical method.

I understand that I do not own any intellectual property rights related to the photograph(s) and I waive any right to inspect or approve the final use(s) of the photograph(s).

I have read this release and fully understand its contents, and I:

  ___  am 18 years old or older and have the right to sign this agreement

  ___  am the parent/guardian of the minor named below and agree to these conditions  as indicated below.


(Print) Name of Model: ____________________________________________________

Telephone of Model: _____________________________________________________

Signature of Model: _________________________________ Date: _________                                                  

Parent/Guardian Signature, if under 18:

______________________________________________ Date: __________

(Print) Photographer’s Name & Banner Number: _______________________________

(Print) Photographer’s ACU email: __________________________________________

(Print) Photo Title:_______________________________________________________

(Print) Photo Category (Mobile, Color, Black & White): ___________________________