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Model Release Form

Name of model: ……………………………………….……….…....................……...........…….

Address of model: …………………………………………………………….…......…………….

……………………………………………………………………………….....….……….……….…

Date of birth of model (if model under 18): ….…/….…/….…

I agree that the Royal Society of Chemistry may use photographs, film or other images of the

model (whose details are shown above) to promote the organisation’s charitable and commercial

interests. The Royal Society of Chemistry retains ownership/copyright of all photographs/videos and will

not disclose any content to third parties.

If model is under 18, name of parent / legal guardian:………………………………………………….

Address of parent / legal guardian (if different from above): ………………………………………..…..

…………………………………………………………………………………………………………...……

Signed by model or model’s parent / legal guardian if he / she is under 18:

Signature………………………………………………………………………………….......................…..

Date: ….…/….…/….…

To be completed by the Royal Society of Chemistry photographer/staff

Photographer

Place of photography

Date of photography

Photography project

Character depicted by model

Colour of jumper/dress/jacket