Your business name

Model Consent and Release � Website Content

Model's Real Name (please print) _____________________________________

Session Date ______/______/______

the past. Maiden Name:_________________________  Other Names:________________________________

___________________________________________________________________________________ ___________________________________________________________________________________

Address_________________________________ Email: _________________________

City________________________ State______ Zip______________ Date of Birth: ______/_______/______

Phone_______________________________ Driver's License #____________________________

Social Security Number ________-_____-_______

We, the undersigned model and photographer hereby agree to accept all conditions set forth in this consent and release.

The undersigned model, hereby gives the undersigned photographer, his clients and/or assigns, unlimited permission to: publish, copyright, sell, distribute and/or display images and video of the model's likeness whether clothed or nude created on the date(s) above in any media chosen by the photographer.

The Model hereby releases and discharges the undersigned photographer, his/her clients and/or assigns from any and all liability by virtue of distortion, blurring, alteration, optical illusion and/or use in composite form, whether the same is intentional, or otherwise. We understand that the photographer, his clients or assigns may use any process or procedure resulting in the completion of the finished product, the publication, distribution, or public display.

By signing this consent and release form, the undersigned model, represents that she/he is of legal age (18 years or older) in the state in which this consent and release form is executed (Your state). The undersigned model certifies that the identification she has submitted is a valid government document and that the image and age information on it is correct and applies to her/him. The undersigned model certifies that the information on this form is correct and current as of the day of the photo shoot. The undersigned model certifies that before signing this document that she/he has read it completely and understand it, and are bound, as is her/his estate. The model releases the undersigned photographer and gives up any and all future claims and rights to the images and video produced on the above date.

No rights are granted to the model or her assigns to use these images for any purpose.

Compensation:

In compensation for the models time and release of rights she will receive payment at the rate of :

$____per hour multiplied by _____hrs = $______.  Travel expenses = _______  Total Compensation = _____

I, the undersigned model, hereby affirm that I received payment in the above amount in the form of

(Circle one) CASH   CHECK   OTHER   Models Initials ___________

The undersigned model certifies that she is an independent contractor and is not nor ever has been a permanent employee of Your name or company name.   Models Initials ___________

Model's Signature  ________________________________________

Photographer

Photographer's Signature ________________________________

Your full name and address

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