MODEL RELEASE FORM

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Model release number
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Photographer name
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Model name
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Address
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City
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Zip/ Postal Code
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Phone Number
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Email

For valuable consideration, hereby received, I irrevocably consent to and authorize the use and reproduction by you, or anyone authorized by you, of any and all photographs which you have this day taken of me, negative or positive, mechanical or electronic, for any purpose whatsoever, without restriction, and without further compensation to me.

All negatives, positives, video or audiotapes, electronic files, together with any prints shall constitute your property, solely and completely.

I hereby release, discharge and save harmless the photographer, his/her representatives, assigns, employees, or any person or corporation acting under the permission of the photographer, including any firm publishing or distributing the finished product, even though the finished product may be distorted, blurred, altered or used in composite forms, in conjunction with factual or fictional text, either intentionally or otherwise and subject me to scandal, scorn, ridicule, reproach or indignity. I hereby waive any right to approve the finished photograph, or any copy, which might be used in conjunction with the finished photograph.

If I am below the age of majority, (usually 18 but sometimes 21,) in the legal jurisdiction applicable to this agreement, the agreement has been signed or approved by the parent or guardian.

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Signature
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Date

I hereby certify that I am the parent or legal guardian of the above named model, and for value received I do give my consent without reservations to the forgoing on behalf of him, her, or them.
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Name
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Relationship to Model
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Signature
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Date

Witness: _______________________
Name: _________________________
Address: _______________________