MODEL RELEASE FORM
This Model Release Form relates to the following photographs and/or images (the "Work"):
________
I, ________, of legal age, with address at ________, consent, agree and authorize ________, of legal age, and with address at ________ (the "Publisher"), together with any officers, employees, directors, agents, contractors, assignees, licensees, transferees, successors, legal representatives, or other representatives of the Publisher (the "Publisher's Representatives"), to use, publish, reuse, republish, distribute, disseminate, or otherwise make publicly available the Work for any lawful use that the Publisher or any of the Publisher's Representatives determine in their absolute discretion, including the use of my name without restriction. The Publisher shall also be specifically permitted to use fictitious names in conjunction with the Work.
I further completely release and discharge Publisher and Publisher's Representative's from any and all demands or claims which I may have at any time that may arise out of or otherwise be connected with the use of the Work featuring me, my image, or my property, including any and all claims for the violation of a right of publicity, a right of privacy, or libel arising in connection with the Publisher's use of the Work, except as provided in this Model Release Form. I likewise completely release and discharge Publisher and Publisher's Representatives from any liabilities in connection to any blurring, distortion, alteration, or processing of the Work unless the same was maliciously caused and published for the purpose of subjecting me to ridicule, scandal, reproach, scorn, and indignity. I acknowledge that all right, title, and interest in or relating to the Work belongs to the Publisher absolutely. I also waive any and all rights to approve or otherwise review any use of the Work featuring me, my image, or my property.
This authorization and release shall inure to the benefit of the legal representatives, licensees, heirs, and assigns of the Publisher and shall be binding upon me, my heirs, assignees, and legal representatives.
5 52522 2552 2588 22528 8282582 2252 85588 82 22825225 525 82225252225 82 5882555282 8825 252 8588 22 252 82258888 22 252 25888228228 525 852585 522 252888822 22 2588 22528 8282582 2252 82 255225 82 52 52252258522 82552 22 822222222 255885882822 58 8285885, 82 85588 222 522282 522 22 252 522582822 2528888228 82 522 852, 22 252 252222 22888882.
Signed this day of ______ day of _____________________, 20______ at the City/Municipality of _____________________, Province of _____________________.
________
Model
MODEL RELEASE FORM
This Model Release Form relates to the following photographs and/or images (the "Work"):
________
I, ________, of legal age, with address at ________, consent, agree and authorize ________, of legal age, and with address at ________ (the "Publisher"), together with any officers, employees, directors, agents, contractors, assignees, licensees, transferees, successors, legal representatives, or other representatives of the Publisher (the "Publisher's Representatives"), to use, publish, reuse, republish, distribute, disseminate, or otherwise make publicly available the Work for any lawful use that the Publisher or any of the Publisher's Representatives determine in their absolute discretion, including the use of my name without restriction. The Publisher shall also be specifically permitted to use fictitious names in conjunction with the Work.
I further completely release and discharge Publisher and Publisher's Representative's from any and all demands or claims which I may have at any time that may arise out of or otherwise be connected with the use of the Work featuring me, my image, or my property, including any and all claims for the violation of a right of publicity, a right of privacy, or libel arising in connection with the Publisher's use of the Work, except as provided in this Model Release Form. I likewise completely release and discharge Publisher and Publisher's Representatives from any liabilities in connection to any blurring, distortion, alteration, or processing of the Work unless the same was maliciously caused and published for the purpose of subjecting me to ridicule, scandal, reproach, scorn, and indignity. I acknowledge that all right, title, and interest in or relating to the Work belongs to the Publisher absolutely. I also waive any and all rights to approve or otherwise review any use of the Work featuring me, my image, or my property.
This authorization and release shall inure to the benefit of the legal representatives, licensees, heirs, and assigns of the Publisher and shall be binding upon me, my heirs, assignees, and legal representatives.
5 52522 2552 2588 22528 8282582 2252 85588 82 22825225 525 82225252225 82 5882555282 8825 252 8588 22 252 82258888 22 252 25888228228 525 852585 522 252888822 22 2588 22528 8282582 2252 82 255225 82 52 52252258522 82552 22 822222222 255885882822 58 8285885, 82 85588 222 522282 522 22 252 522582822 2528888228 82 522 852, 22 252 252222 22888882.
Signed this day of ______ day of _____________________, 20______ at the City/Municipality of _____________________, Province of _____________________.
________
Model
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