Model Release Form


In valuable and good consideration of my engagement as a model (Participant), upon the
terms herewith stated, I hereby give to _(add your name here)_ (Photographer),
his/her heirs, legal representatives and assigns, those for whom The Photographer is
acting, and those acting with his authority and permission:

a) The unrestricted right and permission forever 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 color or otherwise, made through any and all media now or hereafter known for
illustration, art, promotion, advertising, trade, or any other purpose whatsoever.

b) I also permit the use of any text material in connection therewith.

c) 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 may be used in
conjunction therewith or the use to which it may be applied.

d) I hereby release, discharge and agree to save harmless the Photographer, his/her heirs,
legal representatives or assigns, and all persons functioning under his/her permission or
authority, or those for whom he/she is functioning, from any liability by virtue of any
blurring, distortion, alteration, optical illusion, or use in composite form whether
intentional 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 libel or invasion of privacy.

e) I hereby affirm that I am over the age of majority and have the right to contract in my
own name. I have read the above authorization, release and agreement, prior to its
execution; I fully understand the contents thereof. This agreement shall be binding upon
me and my heirs, legal representatives and assigns.
I am also aware that these terms are subject to negotiation, deletion or addendum, which
may be valid if handwritten on this release and initialed and dated by both parties (The
Photographer and Undersigned) next to the modification or any modification that is typed
and signed by both parties. Modifications may be implied by any releases/contracts with
my employer without my notice by the Photographer.
Phone number or e-mail
Date Signed: ____/____/____
Name of Participant
Signature of Participant
Signature of Witness