Information
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Document No.
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Model Name
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Date and Time
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Photographer
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Location
Model Information
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Photographer Name
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Picture Of Model:
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Model Name
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Model Address
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Model Phone Number
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Model Email Address:
Release Details
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In consideration of my engagement as a model, upon the terms herewith stated, I hereby give to the photographer, His / Her heirs, legal representatives and assigns, those for whom the photographer is acting, and those acting with His / Her authority and permission:
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The unrestricted right and permission to copyright and use, re-use, publish, and republish photographic portraits or pictures of me or in which I may be included intact or in part, composite or distorted in character or form, without restriction as to changes or transformations in conjunction with my own or a fictitious name or reproduction hereof in colour or otherwise, made through any and all media now or hereafter known for illustration, arts,promotion,advertising,trade, or any other purpose whatsoever.
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I also permit the use of any printed material in connection therewith.
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I hereby relinquish any right that I may have to examine or approve the completed product or products or the advertising copy or printed matter that maybe used in conjunction therewith or the use to which it maybe applied.
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I hereby release, discharge and agree to save harmless the photographer, His / Hers Heirs, legal representatives or assigns, and all persons functioning under His / Her permission or authority, or those for whom He / She is functioning, for any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form whether international or otherwise, that may occur or be produced in the taking of said picture or in any subsequent processing thereof, as well as any publication thereof, including without limitation any claims for liable or invasion of privacy.
Consent for Legal Adult
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I hereby affirm that I am over the age of 18, and have the right to contract in my own name.<br>I have read the above authorisation, release and agreement, prior to its execution; I fully understand the contents thereof.<br>This agreement shall be binding upon me and my heirs, legal representatives and assigns.
Date and Signature
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Date and Time Signed
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Model or Parent/Guardian
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Photographer
