In consideration of ___________
Dollars ($____________), and other valuable consideration, receipt of which is
acknowledged, I,
_______________________________________________________________ (print Model’s
name), do hereby give ________________________________________________ (the
Designer), his or her assigns, licensees, successors in interest, legal
representatives, and heirs the absolute and irrevocable right to use my name
(or any fictional name), picture, portrait, or photograph in all forms,
including in whole or in part, in all manners, and in all media, whether now
known or hereinafter discovered, without any restriction as to changes or
alterations (including but not limited to composite or distorted
representations or derivative works made in any medium) for advertising, trade,
commercial, promotion, exhibition, editorial, or any other lawful purposes. I
acknowledge that I have no rights with respect to the photograph(s) and I waive
any right to inspect or approve the photograph(s) or finished version(s)
incorporating the photograph(s), including written copy, if any, that may be
created and appear in connection therewith. I hereby release and agree to hold
harmless the Designer, his or her assigns, licensees, successors in interest,
legal representatives and heirs 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 the
photographs, or in any processing tending toward the completion of the finished
product, unless it can be shown that they and the publication thereof were
maliciously caused, produced, and published solely for the purpose of
subjecting me to conspicuous ridicule, scandal, reproach, scorn, and indignity.
I agree that the Designer owns the copyright in these photographs and I hereby
waive any claims I may have based on any usage of the photographs or works
derived therefrom, including but not limited to claims for either invasion of
privacy or libel. I am of full age* and competent to sign this release. I agree
that this release shall be binding on me, my legal representatives, heirs, and
assigns. I have read this release and am fully familiar with its contents.
Witness___________________________________ Signed_______________________________________
Model
Address___________________________________ Address_______________________________________
Date ___________, 20 ___
Consent
(if applicable)
I am the parent or guardian of the minor named above and have the legal
authority to execute the above release.
I approve the foregoing and waive
any rights in the premises.
Witness___________________________________
Signed______________________________________
Parent
or Guardian
Address__________________________________
Address_____________________________________
Date ___________, 20 ____
*Delete this sentence if the subject
is a minor. The parent or guardian must then sign the consent.
Attach visual reference for model here, such as a photocopy
of a driver’s license or other identifying image.