Photographer/Filmmaker Model

Model Release

For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, I ____________________________

_________________________[Parent or Guardian of model] hereby grant to _____________________________________________ (the “Photographer/Filmmaker”), his heirs, legal representatives, and assigns, those for whom the Photographer/Filmmaker is acting, and those acting with his authority and permission, the irrevocable and unrestricted right and permission to copyright, in his own name or otherwise, and use, re-use, publish, and republish photographic portraits or pictures or video of model I represent, in whole or in part, as part of a composite or distorted in character or form, without restriction as to changes or alterations, in conjunction with model I represent or a fictitious name, or reproductions thereof in color or otherwise, made through any medium at his studios or elsewhere, and in any and all media now or hereafter known for illustration, promotion, art, editorial, advertising, trade, publishing, or any other purpose whatsoever. I also consent to the use of any printed matter in connection therewith.

I hereby waive any right that I may have to inspect or approve the finished product or products and the advertising copy or other matter that may be used in connection therewith or the use to which it may be applied.

I hereby release, discharge, and agree to save harmless the Photographer/Filmmaker, his heirs, legal representatives and assigns, and all persons acting under his permission or authority or those for whom he is acting, 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 such photographic portraits or pictures or video or in any subsequent processing thereof, as well as any publication thereof, including without limitation any claims for libel or invasion of privacy.

I warrant and represent that I am the father/mother/guardian of ________________________________________________, the Model. I have read the above authorization, release, and agreement, prior to its execution, and I am fully familiar with the contents thereof. This release shall be binding upon me and my heirs, legal representatives, and assigns.

Photographer/Filmmaker Model

Name (print) _______________________________________ Name (print) _______________________________________

Signature Date _________ Signature __________________ Date of Birth ___________ Phone _____________________

Phone ______________ Address _______________________ Address __________________________________________

City _________________ State ________ Zip _____________ City _________________ State _________ Zip ___________

Country _______________ Email: ______________________ Country ______________________ Date ________________

Shoot location _________________________________________________________________________________________

Shoot Date _________ Shoot Description ________________________________________________________________________

Parent(s) or Guardian(s)

Name (print) _____________________________________________________ Signature__________________________________

Date _____________ Phone ________________________ Address ___________________________________________________

City ____________________ State __________ Zip ____________ Country ______________ Email: _________________________