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
Name or Organization
City, State, Zip
Permission to Use Photograph
I grant to [insert name or organization], the right to take photographs of me and
my family in connection with the above-identified event. I authorize [insert
organization], its assigns and transferees to copyright, use and publish the same
in print and/or electronically.
I agree that [insert name or 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:
Printed name ______________________________
Signature, parent or guardian _______________________
(if under age 18)