Fillable Printable Blank Model Consent Form Sample

Blank Model Consent Form Sample

Model Consent Form

For monetary consideration received, I hereby grant to:

_____________________________________________________________________________________________

(“Photographer”) the following absolute and irrevocable right and permission as it concerns to any and all of the

photographs that the above listed photographer has taken or may take of me, including photographs where I may

be included with others, to use, and or to reuse, publish and or to republish the photographs in whole or in part,

this may include the internet and may be for any purpose whatsoever, including but not limited to illustration,

promotion, editorial, marketing, art, without any restriction as with regard to alteration; and to use my name in

connection with any use that the above listed photographer may choose.

I hereby release and discharge the Photographer from any use that they may choose. I release and discharge the

above listed Photographer from any and all claims that may arise out of or may develop in connection with the use

of all of the photographs taken this may include but not limited to any and all claims for libel or violation of any

right of publicity or privacy.

This Model Consent form authorization and release shall pertain to the benefit of all heirs, legal representation

and Photographer assignees as well as the person(s) for who the Photographer as well as the person for who the

Photographer has take the photograph.

I am a legally competent adult and do hereby have the right to contract in my own name. I have read this Modal

Consent form completely and fully understand the contents of the entire document. This release shall be binding

upon me and my heirs, legal representation and their representatives.

Signature: ___________________________________________________________________ Date: ___/___/_____

Name: ________________________________________________________________________________________

Address: ______________________________________________________________________________________

City: __________________________________________ State: ______________ Zip Code: ___________________

Witness Signature: ____________________________________________________________ Date: ___/___/_____

Name: ________________________________________________________________________________________

Address: ______________________________________________________________________________________

City: __________________________________________ State: ______________ Zip Code: ___________________