MODEL RELEASE AND CERTIFICATION
MODEL______________ NR _____
For and in consideration of my engagement as a model by _________ (the "Photographer"). In the event such photographs, films and/or videos are sold, and in further consideration of the publicity to be received by the undersigned by the use of such photographs, I hereby give the Photographer, his or her agents, representatives and assigns, those for whom he or she is acting, and those acting with his or her permission of authority, and his or her respective agents and employees, and any person or entity who may hereafter publish the photographs, films and/or video (hereinafter collectively referred to as the "Users") the absolute right and permission to copyright in its own name, use, reuse, publish, exhibit, display, print and reprint 'in advertising material, television, motion pictures, magazines, books, video recordings, audio recordings, interact or any other media, known or unknown at this time, and for any other purposes as they may see fit, in their sole and absolute discretion, the films, photographs, video and audio recordings, negatives, prints of every kind and nature, illustrations, portraits made from the photographs pictures, designs, paintings and drawings of every kind of nature heretofore taken, or taken this day, ore hereafter taken, including, without limitation, reproductions thereof in which I may be included in whole or in part (hereinafter collectively referred to as the "Photographs'). Such Photographs mat be used in any way by the Users for purpose of trade, advertising, publicity or promotion of any kind without restriction. The failure of Photographer to pay for such use shall not be deemed as a failure of consideration by any other Users. World rights and multiple use are hereby authorized.
I hereby waive any rights to inspect or approve the Photographs or the editorial or advertising copy or printed matter that may be used by the Users in conjunction therewith. I further waive any claims that I may have to the eventual use to which it may be applied. Such Photographs may be used, in sole discretion of the Users, with or without my name. and/or fictitious name, and with fictitious or accurate quotations, interviews or biographical material. The Users mat use the Photographs and accurate or fictitious statements attributed to me which may constitute endorsement of services or products, in the sole discretion of the Users. I hereby release, discharge and agree to defend, indemnify and save harmless the Photographer and Users, their legal representatives, licensees, successors and assigns, and all parties acting under their permission, or with authority from them, or those for whom they are acting, from and against any and all losses, damages, costs, charges, attorneys' fees, recoveries, actions, judgements, penalties, expenses and anv or other loss whatsoever which may be obtained against, imposed upon or suffered by all or any of them which arise from the use of such Photographs, even should the same subject me to ridicule, scandal, reproach, scorn or indignity, and from any liability as a result of any distortion, blurring or alteration, optical illusions, or use in composite form, either intentionally or otherwise, that may occur or to be reproduced in the taking, processing or reproduction of the finished product, or its publication or distribution, or which may arise from any breach of any warranty representation, covenant or agreement made by me. I waive any claim that I may have for alleged violation of privacy, defamation or libel by the use of such Photographs.
I hereby represent that I am over the age of 18 years and have read the authorization and release prior to its execution. I have not been induced to sign the same other than by the recited considerations, by any representation or statement made by the Photographer, his or her agents, employees, or anyone acting on his or her behalf The Photographer, as primary producer, hereby cities to all Users that the visual depictions covered by this release satisfy the standard under paragraphs (a) (1) through (a) (3) of Section 75.7 of the Regulations implementing 18 U.S.C, $ 2257 and do not depict actual sexually explicit conduct.
Photographer's Name Date
Photographer's Address Code City Country
The photographer has been shown and attaches hereto a legible copy of the following identification items as proof of the age of the model, one of which is a picture identification issued by a state or federal government or private entity, bearing the photograph and the name of the Model.
Model's Name Date
Model's Address Code City Country
Model's Date of Birth
Model's IC/Passport nr
Model's professional name
Signature of Witness
Name of witness Date
Address of Witness Code City Country