The absolute and irrevocable right and permission, with respect to the photographs and film or tape that he/she has taken of me on
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Date
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at Location

(a) To copyright the same in his/her own name or any other name that he/she may chose.

(b) To use, re-use, publish, and re-publish the same in whole or in part, individually or in conjunction with other photographs or images, in any medium and for any purpose whatsoever, including (but not by way of limitation) illustration, promotion, advertising and trade, and

(c) To use my name in connection therewith if he/she so choses. I hereby release and discharge the Photographer, his/her heirs, executors, assigns and any designee (including any agency, client, broadcaster, periodical or other publication) from any and all claims and demands arising out of or in connection with the use of such photographs, film, or tape, including but not limited to any claims for defamation or invasion or privacy.

I am of legal age and have read the foregoing and fully understand the contents thereof.

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Signature
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Date
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Print Name
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Witnessed by
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Notes
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