This is the form we have used for many years. We print it on our company letterhead and add in the photographers name, the subjects name, and the exact uses we are giving permission for i.e. personal photographic prints, or one time use in a yearbook, or website and business cards only. I hope this is what you were looking for.
Today’s Date
From: Your Name
Your Company
Your Address
Your City, State Zip
To whom it may concern:
I am ____________________________ and I am the creator and copyright owner of these images. I give my permission for you to reproduce my copyrighted images of _________________________ for _________________________________________ Federal and International copyright laws strictly prohibit all other uses of these images without further written authorization.
Sincerely,
Your Name and Title
Your Company