Declaration of the Model
In consideration of my employment as a model by the above mentioned photographer/videographer for the fee stated, receipt of which is hereby acknowledged, I hereby sell, assign and grant to the photographer/videographer, his/her legal representatives and assigns, or those for whom the photographer/videographer is acting, and those acting with his/her authority, and permission, or his employees, the irrevocable and unrestricted right and permission to copyright in his/her own name or otherwise, and use, reuse, publish and/or republish video and/or photographic pictures or portraits of me in which I may be included in whole or in part, without restrictions as to changes or alterations, in conjunction with my own name or a fictitious name, in color, or in black and white, or reproductions of such photographs, made through any and all media now or hereafter known for illustration, promotion, art, editorial, advertising, trade, or any other purpose whatsoever, by the photographer/videographer at his studio or elsewhere, including the use of any printed matter in conjunction with such photographs.
I hereby waive my right to inspect and/or approve the finished video and/or photograph or photographs, or product or products, or advertising copy or printed matter that may be used in conjunction with such photographs or video, or to the eventual use to which it may be applied.
I hereby release and discharge the above, its assigns, and all persons acting with the photographer/videographers permission or authority, or those for whom the photographer/videographer is acting, from and against any liability as a result of any distortion, blurring, alteration, or optical illusion that may occur in the taking of the picture or video, or processing or reproduction of the finished product, and from any claims for remuneration associated with any form of damage, foreseen or unforeseen, associated with the proper commercial or artistic use of these images, unless it can be shown that said reproduction was maliciously caused, produced and published for the sole purpose of subjecting the model to conspicuous ridicule, scandal, reproach, scorn, and indignity.
I hereby acknowledge that the photography and/or video session was conducted in a completely proper and professional manner, and this release was willingly signed.
I hereby warrant that I am of full age and not a minor, and competent to contract in my own name insofar as the above is concerned. I have read the foregoing release, authorization and agreement, before affixing my signature below, and warrant that I fully understand the contents thereof. I have received the fee stated below.
Date Model's Signature
Model's Printed Name
Email Address Phone Number
Model's Date of Birth
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