Model Release Model Information

| Phone 575-637-4371 Name

| website www.modelmayhem.com/fotojoey ________________________________________________________
Email-fotojoey@live.com Address
For good and valuable Consideration 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 (except pornographic or City __________________________________
defamatory) which may include, among others, advertising, promotion, State/Province _____________
marketing and packaging for any product or service. I agree that the Country _____________________________
Images may be combined with other images, text and graphics, and Zip/Postal Code _____________
cropped, altered or modified. I acknowledge and agree that I have Phone _______________________
consented to publication of my ethnicity(ies) as indicated below, but Email _____________________________
understand that other ethnicities may be associated with Images of Date of Birth
me by the Photographer/Filmmaker and/or Assigns for descriptive _____________________________________________________
purposes. Signature
I agree that I have no rights to the Images, and all rights to the Images _______________________________________________________
belong to the Photographer/Filmmaker and Assigns. I acknowledge Date
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 Parent(s) or Guardian(s) (if person is a minor or lacks capacity in the
that this release is binding upon my heirs and assigns. I agree that this jurisdiction of residence.) Parent warrants and represents that Parent is
release is irrevocable, worldwide and perpetual, and will be governed the
by the laws of Newmexico legal guardian of Model, and has the full legal capacity to consent to
I represent and warrant that I am at least 18 years of age and have the the
full legal capacity to execute this release. Shoot and to execute this release OF ALL RIGHTS IN MODEL’S
Definitions: IMAGES.
“MODEL” means me and includes my appearance, likeness and form. Name (print)
“MEDIA” means all media including digital, electronic, print, _____________________________________________________
television, film Address
and other media now known or to be invented. ________________________________________________________
“PHOTOGRAPHER/FILMMAKER” means photographer, illustrator, _________________________________________________________
filmmaker _______
or cinematographer, or any other person or entity photographing or City __________________________________ State/Province
recording me. _____________
“ASSIGNS” means a person or any company to whom Photographer/ Country _____________________________ Zip/Postal Code
Filmmaker has assigned or licensed rights under this release as well as _____________
the Phone _______________________ Email
licensees of any such person or company. _____________________________
“IMAGES” means all photographs, film or recording taken of me as Signature
part of _______________________________________________________
the Shoot. Date
“CONSIDERATION” means something of value I have received in _________________________________________________________
exchange __
for the rights granted by me in this release.
“SHOOT” means the photographic or film session described in
My Rules
this form.  All Photographs are printed and edited
“PARENT” means the parent and/or legal guardian of the Model.
Parent and by ONLY Photographer
Model are referred to together as “we” and “us” in this release.
Photographer Information  You Must first get permission to edit or
Name (print)
_________________________________________________
alter the Image
 All models must be 18 or have an adult
City __________________________________ State/Province
_________ sign this form.
Country ___________________________ Zip/Postal Code
___________
Phone ______________________ Email
__________________________
Shoot Date
__________________________________________________
Shoot Description/Reference
____________________________________
Signature
___________________________________________________
Date
_______________________________________________________
Model Information
Name (print)
_____________________________________________________