In consideration of my
engagement as a model, upon the terms herewith stated, I hereby give
to "BearPhotograpfer" his, legal representatives and assigns, those for whom
"BearPhotograpfer" is acting, and those acting with his authority and
permission:
a) For the images
captured on , the unrestricted right and permission to copyright and
use, re-use, publish, and republish photographic portraits or pictures
of me or in which I may be included intact or in part, composite or
distorted in character or form, without restriction as to changes or
transformations in conjunction with my own or a fictitious name, or
reproduction hereof in color or otherwise, made through any and all
media now or hereafter known for illustration, art, promotion,
advertising, trade, or any other purpose whatsoever.
b) I also permit the
use of any printed material or electronic media in connection
therewith.
c) I hereby relinquish
any right that I may have to examine or approve the completed product
or products or the advertising copy or printed matter that may be used
in conjunction therewith or the use to which it may be applied.
d) I hereby release,
discharge and agree to save harmless "BearPhotograpfer", his/her heirs, legal representatives or assigns, and all
persons functioning under his/her permission or authority, or those
for whom he/she is functioning, from any liability by virtue of any
blurring, distortion, alteration, optical illusion, or use in
composite form whether intentional or otherwise, that may occur or be
produced in the taking of said picture or in any subsequent processing
thereof, as well as any publication thereof, including without
limitation any claims for libel or invasion of privacy.
e) I hereby affirm that
I am over the age of majority and have the right to contract in my own
name. I have read the above authorization, release and agreement,
prior to its execution; I fully understand the contents thereof. This
agreement shall be binding upon me and my heirs, legal representatives
and assigns.
f) Compensation for
this activity shall
be:
_________________________________________________________________
Model's Name:
_______________________________________________________
print legal name with
desired alias if any in parenthesis
Signature:
__________________________________________ Dated: __________
Address:
___________________________________
City:
_______________________________________
State/Zip:
__________________________________
Phone:
_____________________________________
Witness Name:
______________________________
Signature:
__________________________________________
Dated: __________
