MODEL AGREEMENT AND RELEASE

(Office use only) Project:       Image #s:      

AGREEMENT AND RELEASE OF MODEL

For valuable consideration, the receipt of which is hereby acknowledged, I, the undersigned, hereby:
1) Consent to being the subject of artwork, and/or photographs, and/or video recording, and/or audio recording (hereafter “the
Depictions” whether one or more) taken by, or at the direction or authority of, Watchtower Bible and Tract Society of New York, Inc.,
and/or Watch Tower Bible and Tract Society of Pennsylvania (hereafter collectively “Watchtower”);
2) Transfer and convey to Watch Tower Bible and Tract Society of Pennsylvania all of my right, title, and interest in and to the
Depictions and any copyrights related thereto, including all renewals and extensions of any such copyrights or other rights that may
be secured under all laws and treaties now or in the future in force in the United States of America;
3) Authorize Watchtower and any person or entity authorized by Watchtower to use the Depictions: (i) with or without my name, at
Watchtower’s discretion; (ii) separately and/or together with any subject matter; (iii) as still photographs, transparencies, motion
pictures, television, video, or other visual media; (iv) for reproduction in any medium Watchtower deems appropriate; (v) for any
purpose and in any form Watchtower desires; and (vi) without my prior inspection or approval; and
4) Release Watchtower, its agents, officers, directors, and members from any and all liability or claims of damage and/or injunctive
relief as a result of the taking and/or use of the Depictions. I agree to keep the fact that the Depictions exist confidential until
Watchtower publishes them in some written, audio, video, or other form. This Model Agreement and Release is the entire agreement
between Watchtower and the undersigned and is subject to and shall be construed under the laws of the State of New York and the
U.S.A.

Description of Depictions to which this Model Agreement and Release applies

     

Model’s Name and Address

Please print

Full Legal Name:      

Street:       Phone:(     )      -     

City:       State:       Zip Code:      

Model’s Date of Birth:      

q If model is under 18 years of age, a parent or legal guardian must sign the Consent below.

Model’s Signature: X Date:

PARENT/LEGAL GUARDIAN'S CONSENT

I, the undersigned, affirm that I am the parent or legal guardian of the above-named model. As such parent/legal
guardian, for myself and the above-named model, I hereby approve of and consent to all of the provisions of the
foregoing Agreement and Release of Model. I affirm that I have the legal right to issue such consent.
Parent/Legal Guardian’s Name and Address
printPlease

Full Legal Name:      

Street:       Phone:(     )      -     

City:       State:       Zip Code:      

Parent/Legal Guardian’s X Date:
Signature:
IS 8/2012