Fillable Printable Universal Adult/Minor Model Release

Universal Adult/Minor Model Release

Universal Adult / Minor Model Release

Model Release (all fields required) Date: ____________ ____

For good and valuable consideratio n, the receipt and sufficiency of which is hereby acknowledged, I hereby grant

to:____________________________________ (the “Photographer”), his/her heirs and legal representatives the irrevocable

and unrestricted right a nd permission to cop yright, in his/her own name or otherwise, and use, re-use, publish, and re-publish

photographic portraits or pictures 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 alterat ions , in co njunction with my own or a fictit ious name, or

reproductions thereof in color or otherwise, made through any medium at his/her studios or elsewh ere, and in any and all media

now or hereafter known for illustratio n, promotion, art, editorial, advertising, trade, publishing, or any other purpose

whatsoever (except pornographic or defamatory). I also consent to the use of any printed matter in connection th erew ith.

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 connectio n therewith or the use to whic h it may be appli ed.

I hereby release, discharge, and agree to save harmless the Pho tographer, his/her heirs , legal representatives and a ssigns, and

all persons acting under his/her permission or authority or those for whom he/she 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 in any subs equent processing thereof, as well as any

publica tion thereof, includ ing withou t limitation any claims for libel or invasion of pr ivacy .

I hereby warrant that I a m of full legal age and have the right to contract in my own name. I have read the above authorizat ion,

release, and agreement, prio r to its execution, and I am fully familiar with the contents thereof. This release shall b e binding

upon me and my heirs, legal representatives, and assigns.

Model, Parent or Guardian (if minor)

Name model: (print) ______________ _________ _______ ________ ______ _________ _______ ___

Name parent or guardi an if model is a minor: (print)______ ________________________________

Address:_________________________________________

City: _____________________________ State ______ ______ ___________Zip_________

Country____________________________Email:___________________________Phone:___________________

Signature:__________________________

Photographer

Name: (print) ____ _________ ______ _________ ____________________ _______ ______

Phone:_____________ _______________Address:__________ ____________________ _________ _______

City:______________________________State ____________________ _______Zip______________

Country_______________________ ___Email:_______________________

Signature:__________________________

Witness (NOTE:

All persons signing and witnessin g must be of legal age.

You cannot witness your own release.)

Name: (print) _____________ ______ _________ _______ ___

Address: ________ ________ _________________________

Zip:___________________City: _____________ __________

Country: __________________ ________ _________

Signature: __________ _______ ____________

Photo of Model Goes here

(Optional)