MODEL RELEASE: 2257 COMPLIANCE FORM:

Model Name:
Model's Legal Name
All other names ever used,
including married names,
maiden name, stage
names, nicknames, aliases,
etc.



Identification produced: 1
st
form of identification produced (Choose 1)
Picture identification card:
Issued by what government
entity?

Drivers License number
Passport -number
State identification card -
number




Work Identification card

Date of Birth of model
Address of model
City:
State:
Country:


Identification produced: 2
nd
form of identification produced (Choose 1)
Picture identification card:
Issued by what government entity?
Drivers License #
Passport #
State identification card
School I.D. #
Selective service card #
Work Identification card #
Other #


TERMS AND CONDITIONS:
I, the undersigned model (hereafter model) do hereby voluntarily authorize and give
permission to .......................................................................... (hereafter photographer). to
the exclusive use of: photographs, video, electronic and digital reproductions in any form
of my person or personal property

From the date of execution of this General Release and Authorization, the undersigned
hereto does hereby grant, release and assign to photographer any and all claims of right
whatsoever in and to all photographs or printed materials of the undersigned or by the
undersigned and delivered to photographer for any purpose chosen by photographer.

From execution hereto and for value received and acknowledged below by model,
photographer shall exclusively and irrevocably own in perpetuity all right, title and interest,
including copyright, in and to the digitized photographs, reproductions, video and any
digitized printed material of the undersigned with no rights expressly reserved by the
model.
Model also grants photographer and its designees the right to use her name, likeness,
image voice, appearance, and performance as embodied in the Product whether recorded
on or transferred to videotape, film, slides, photographs, audio tapes, or other media, now
known or later developed. This grant includes without limitation the right to edit, mix or
duplicate and to use or re-use the Product in whole or part as photographer may elect.
photographer or its designee shall have complete ownership of the Product in which
model appears, including copyright interests, and model acknowledges that she has no
interest or ownership in the Product or its copyright. a) the unrestricted right and
permission to copyright and use, re-use, publish, and republish photographic portraits,
video or pictures of me or in which I may be included intact or in part, composite or
distorted in character or form, without restriction as to changes or transformations in
conjunction with my own or a fictitious name, text or fictitious story line, or reproduction
hereof in color or otherwise, made through any and all media now or hereafter known for
illustration, art, promotion, advertising, trade, profit, web media or any other purpose
whatsoever.
I also permit the use of any printed or electronic or digital broadcast material, that could
be connected with said media in connection therewith
I hereby relinquish any right that I may have to examine or approve the completed product
or products, images, video or text advertising copy or printed or digital broadcast matter
that may be used in conjunction therewith or the use to which it may be applied.
I hereby release, discharge and agree to save harmless photographer , his/her heirs,
legal representatives or assigns, and all persons functioning under his/her permission or
authority, or those for whom he/she is functioning, from any liability by virtue of any
blurring, distortion, alteration, optical illusion, fictitious names, fictitious story lines, or use
in composite form whether intentional or otherwise, that may occur or be produced in the
taking of said picture, video or in any subsequent processing thereof, as well as any
publication thereof, including without limitation any claims for libel or invasion of privacy.
Model also confirms that she/he has the right to enter into this Agreement, that she/he is
not restricted by any commitments to any parties, and that photographer has no financial
commitment or obligations to me as a result of this Agreement besides the consideration
already paid.
I hereby give all clearances, copyright and otherwise, for use of my name likeness, image
voice, appearance and performance embodied in the Product. I expressly release and
indemnify photographer and its officers, employees, agents and designees from any and
all claims known and unknown arising out of or in any way connected with the above
granted uses and representations. The rights granted photographer herein are perpetual
and worldwide survive my death and any other occurrence.
In consideration of all the above, I hereby acknowledge receipt of reasonable and fair
consideration from the Photographer named below, received and paid.


AS TO MODEL:
MODELS
SIGNATURE:

Dated on:
I the above-signed model do hereby certify and swear under declaration of perjury that the
following is true and correct by my above signature and that I agree with such terms.
I swear that I am above 18 years of age
I swear that I have disclosed my correct legal name
I swear that I have disclosed all other names that I have been known by
I swear that I have produced legal identification cards
I swear that I have not provided any false or misleading information to producer or
photographer

AS TO PHOTOGRAPHER / STUDIO:
Photographer Name:
Company Name:

Address:
Date of Photo Shoot::

AS TO WITNESSES:
I the undersigned witness do hereby swear under declaration of perjury that I witnessed
the above model sign this documents and swear to the above statement.
WITNESS
SIGNATURE

Printed Name
Address
City, State, Country