For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, I __________, (Parent of model) hereby grant to __________ (the “Photographer”), his heirs, legal representatives, and assigns, those for whom the Photographer 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 republish photographic portraits or pictures of model I represent, 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 model I represent or a fictitious name, or reproductions thereof 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 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, 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 in any subsequent processing thereof, as well as any publication thereof, including without limitation any claims for libel or invasion of privacy.

I warrant and represent that I am the father/mother/guardian of __________, the Model. 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
Name

Shoot Date

Signature

Phone

Address

Country/City/Zip/State

Email:

Shoot Description/Reference:

Model
Name
Date of Birth
Phone
Address
Country
City/Zip/State
Email:

Parent(s) or Guardian(s):

Name
Date
Address

State/Zip

Email

Signature

Phone
City
Country

Witness:

Name

Date
Signature