Photographer/Filmmaker Model

Model Release

For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, I ____________________ [model name] hereby grant________________________(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 re-publish photographic portraits or pictures or video of me or in which I may be included, 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 my own or a fictitious name, or reproductions there of 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/video 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 hereby warrant that I am of full legal age and have the right to contract in my own name. 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)_________________________________________

Date_________ Signature_________ Phone__________ Date_________ Signature__________ Phone______________

Address_______________________________________ Address____________________________________________

City__________________ State _________ Zip _______ City __ _____________ ____ State_________ Zip ___________

Country ______________ Email: ___________________ Country ________________ Email: ______________________

Date of Birth ________________________________________

Shoot location ____________________________________________________________ Shoot Date __________________

Shoot Description | Nude £ | No nude £ | __________________________________________________________________

Witness Name(print) ______________________________________ Date _______________ Signature_________________

The place to scan of the first page passports