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Brent Payton
(512) 633-8742 http://photon-art.com |
Model Release |
For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, I do hereby grant to Brent Payton (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 re-publish photographic portraits or pictures of me or in which I may be included, in whole or in part, as a part of a composite or distorted in character or form, without restriction as to changes or alterations, in conjuction with my own 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 wave 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 hold harmless the photographer, his heirs, legal representatives, and assigns, all persons acting under his permission or authority or those for whom he is acting, including, specifically iStockphoto Inc., 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 hereby warrant that I am of full legal age and have the right to contract in my own name. 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.
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Model Name (print): ___________________________________________________________ Date: ___________ *Signature: ________________________________________________ Address: ______________________________________________________________________ City: _________________________________ State: ____________ ZIP: ______________ Telephone 1: (______)___________________ Telephone 2: (______)_________________ E-Mail Address: _______________________________________________________________ |
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Parent or Guardian if the model is a minor or lacks capacity in the jurisdiction of residence Name (print):__________________________________________________________________ Date: ___________ *Signature: __ ______________________________________________ Address: ______________________________________________________________________ City: _________________________________ State: ____________ ZIP: ______________ Telephone 1: (______)__________________ Telephone 2: (______)__________________ E-Mail Address: _______________________________________________________________ |
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Witness:(NOTE: All persons signing and witnessing must be of legal age and capacity in the area in which this release is signed.
A person cannot witness their own release) Name (print): ______________________________________________________________ Date: ____________ *Signature: _____________________________________________ |
*Include a copy of picture identification to verify identity.
P.O. Boxes will not be accepted.
Complete as many fields as possible.