Fillable Printable Blank Model Consent Form Sample
Fillable Printable Blank Model Consent Form Sample
![Blank Model Consent Form Sample](/resources/formfile/images/fb/source_images/blank-model-consent-form-sample-d1.png)
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: ___________________