Photographer                        : _____________________________________________ (hereafter “Photographer”)

 

 

Model’s Real Name               : _____________________________________________ (hereafter “Model”)

 

 

Model’s Stage Names(Alias) : _____________________________________________

 

 

Model’s IDs                            : _____________________________________________

 

 

Model’s Email                        : _____________________________________________ 

 

 

Models Phone                         : _____________________________________________

 

 

Model’s Address                     : _____________________________________________

 

 

Production & Location             : _____________________________________________

 

 

Compensation Details             : _____________________________________________

 

 

For good and valuable compensation which I the Model acknowledge as having being received, the  Model does hereby grant the Photographer, his legal representatives, successors, and all persons or corporations acting under his permission and/or authority, the irrevocable and unrestricted right and permission to copyright, in his own name, and to use, re-use, publish and republish still or motion pictures of me, or in which I may be included, in whole or as a part or in composite form, including the negatives, transparencies, prints or digital information pertaining to them, without restriction as to changes alterations, or reproductions thereof, made through any medium and in any and all media known to date or to be invented, for illustration, promotion, art, editorial, advertising, trade or any lawful purpose whatsoever. I also consent to the use of any printed matter in conjunction therewith.

I hereby waive any right that I may have to inspect or approve the finished product or advertising or other matter that may be used in connection with an image that the photographer has taken of me, or the use to which it may be applied.

I further release the photographer, his legal representatives, heirs, successors and all persons or corporations acting under his permission or authority, from any claims for remuneration associated with any damage or liability, foreseen or unforeseen, associated with the commercial or artistic use of these images or videos.

By my signature below, I certify that I am and adult at least 18 years of age, and freely and willingly give my consent to the terms of this release. In accordance with a broad interpretation of the Title 18 USC, Chapter 10, Section 2257, and Part 28 of the Code of Federal Regulations, Section 75. Both the photographer and I have provided proper verification that each is of full legal age and have every right to contract in his/her own name with regard to this release.

This document also serves as a “release” from the Photographer to photographic labs providing permission for them to print, on behalf of the model, any images shot by the Photographer and which may or may not contain the Photographer’s copyright © warning. 

 

I understand that in signing this document I am relinquishing significant rights with respect to the images of me. I have read the above authorization and release, prior to its execution. I fully understand it, and I fully agree to it.

 

 

 

Model’s Signature             : _____________________________________________ Date :___________________

 

 

 

 

Photographer’s Signature : _____________________________________________ Date :___________________