Model Release Form

Model Release Form - General

Name of Program/Event

Date of Program/Event(Required)

Please indicate your compliance with the statements below.(Required)

I acknowledge that photographs video, and/or audio of my likeness and sound of my voice will be used by Aga Khan Museum for educational, promotional, and display purposes. I voluntarily grant Aga Khan Museum, and representatives and agents, in connection with the photographs, video, and/or audio that I have provided, consent and permission to use, re-use, publish and re-publish the said photographs, video, and/or audio, in whole or in part, individually or in conjunction with other photographs, video, and/or audio for educational, promotional and display purposes by any currently known or subsequently discovered means without restriction as to alteration; and to use my name in connection therewith, if Aga Khan Museum so desires.

Please indicate your compliance with the statements below.(Required)

I acknowledge that no money has been tendered or promised to me for the consent to use the said photographs, video, and/or audio and that my consent is given in perpetuity and for no financial compensation.

Please indicate your compliance with the statements below.(Required)

I hereby release Aga Khan Museum, the Aga Khan Development Network, and each of their respective officers, directors, members, assignees, licensees, representatives, agents and employees and all those for whom they are responsible in law harmless from and against all claims and losses arising in connection with or resulting from any liability arising out of or in connection with the use of the said photograph, video, and audio. Those for whom it is responsible by law and/or all contributors to the above noted content, breach or alleged breach of any agreements, representations or warranties under this Release.

Please check ONE:

I am the subject of the photographs, video, and/or audio. I am 18 years of age and have read the foregoing and fully understand the contents thereof.

I am the authorized guardian/agent of the subject in the photograph, video, and audio. I have read the foregoing and fully understand the contents thereof.

Name of Subject(Required)

First Last

Email(Required)

Phone(Required)

Date(Required)

Name of Subject, Guardian, or Authorizing Party or Agent(Required)

First Last

By entering my name in the field above I acknowledge this acts as a signature to give consent for photos, video, and/or audio to be taken under the terms above.

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Model Release Form - General