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Permission for Photography

For valuable consideration received, I acknowledge that ________________________


("Photographer") and his/her legal representatives and assigns, have the irrevocable and
unrestricted right to use and publish photographs of me, or in which I may be included, for
editorial, trade, advertising, and any other purpose and in any manner and medium; and to
alter and composite the same without restriction and without my inspection or approval. I
hereby release Photographer and his/her legal representatives and assigns from all claims and
liability relating to said photographs.

______________________________
___Model’s Signature ______________________________
_
Witness Signature
______________________________
___Print Name ______________________________
_
Print Name
______________________________
___Model’s Date of Birth ______________________________
_
Address
______________________________
___Address ______________________________
_
Address
______________________________
___Address ______________________________
_
Witness Signature
______________________________
___Email Address ______________________________
_
Print Name
______________________________
___Today’s Date ______________________________
_
Address
______________________________
___ ______________________________
_
Legal Guardian Signature (if under 18)
Address

______________________________
___
______________________________
Print Name _
Today’s Date

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