Photographer Name: ……………………………………………………………………….
Model Release Number: …………………………………………………………………..
Model Name: ………………………………………………………………………………….
Model Phone Number: …………………………………………………………………….
Model E-Mail Address: …………………………………………………………………….
Model Permission And Rights Granted
For good and valuable Consideration of ……………………………………………………………….., herein acknowledged as received, and by signing this release I hereby give the Photographer and Assigns my permission to license the Images and to use the Images in any Media for any purpose which may include, among others, advertising, promotion, marketing and packaging for any product or service. I agree that the Images may be combined with other images, text and graphics, and cropped, altered or modified. I acknowledge and agree that I have consented to publication of my ethnicity as indicated below, but understand that other ethnicity may be associated with Images of me by the Photographer and/or Assigns for descriptive purposes.
I agree that I have no rights to the Images, and all rights to the Images belong to the Photographer and Assigns. I acknowledge and agree that I have no further right to additional Consideration or accounting, and that I will make no further claim for any reason to Photographer and/or Assigns. I acknowledge and agree that this release is binding upon my heirs and assigns. I agree that this release is irrevocable, worldwide and perpetual, and will be governed by the laws of Alberta, Canada, excluding the law of conflicts.
To be Completed by the Model
Model Printed Name: ………………………………………………
Model Date of Birth: ……………………………………………….
Model Ethnicity: …………………………………………………..
Date: …………………………………………………………………….
Model Signature: ………………………………………………….
To be Completed by the Witness
Witness Printed Name: …………………………………………..
Date: ………………………………………………………………………..
Witness Signature: ………………………………………………..
To be Completed by the Photographer
Photographer Name: ………………………………………………..
Date: ……………………………………………………………………..
Photographer Signature: …………………………………………
