This is a typical release form used to secure permission to use an individual’s likeness with or without identification.
From Public Relations Writing & Media Techniques (Fourth Edition) by Dennis Wilcox.
Sample Photo Release Form
Organization Name
Address
City, State, Zip
Permission to Use Photograph
Subject: ____________________
Location: ___________________
I grant to [insert organization], its representatives and employees the
right to take photographs of me and my property in connection with
the above-identified subject. I authorize [insert organization], its
assigns and transferees to copyright, use and publish the same in print
and/or electronically.
I agree that [insert organization] may use such photographs of me
with or without my name and for any lawful purpose, including for
example such purposes as publicity, illustration, advertising, and Web
content.
I have read and understand the above:
Signature _________________________________
Printed name ______________________________
Organization Name (if applicable) __________________________
Address __________________________________
Date _____________________________________
Signature, parent or guardian _______________________
(if under age 18)