CHILLIBABE76 PAGE

For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I______________________________________  [name of model] on my own behalf and on behalf of  _________________________________________ [name of company, if model is an employee acting within scope of employment] (the “Model”) hereby irrevocably acknowledge and agree in favor of the photographer or artist named below (the “Photographer”), and the Photographer’s heirs, executors, legal representatives, licensees, successors and assigns, those for whom the Photographer may be acting, and those who may be acting with the Photographer’s authority and permission (collectively, the “Authorized Parties”) as follows:

1.  In the event photographs, illustrations, video or other images of, including or depicting the Model are taken or created by or on behalf of the Photographer in any media (“Images”), all worldwide right, title and interest in and to the Images and all related materials (including copyright, all other intellectual property and other proprietary rights) shall be owned by the Photographer or as the Photographer may determine.

2.  The Photographer shall have the irrevocable right (which may be licensed, transferred, granted or assigned to other parties as the Photographer sees fit) to use, publish, reproduce, create derivative works of, distribute, publicly perform and publicly display, either digitally or in any other medium now known or later developed, such Images in any form, including without limitation, use as part of a composite or distorted in character or form, without restriction as to text, changes or alterations, whether or not in conjunction with the Model’s name or a fictitious name, for illustration, promotion, art, editorial, advertising, trade, publishing, or any other commercial purpose whatsoever. The Model also consents to the use of any narrative, text, audio, sound, action, program, effect or other matter that may be used in connection with the Images and the permitted uses, and irrevocably waives any right that the Model may have to inspection or approval of any of the deliverables or uses contemplated in this Release. In consideration of the Model’s consent and release, the Photographer will use reasonable commercial efforts to ensure that the Images will not be used for any pornographic, obscene, defamatory or libelous purpose.

3.  The Model hereby irrevocably releases the Photographer and each of the Authorized Parties, and any and all other parties acting under right, title, assignment, grant or license from the Photographer or the Authorized Parties, from any liability, costs or expenses arising by virtue of: (i) any blurring, distortion, alteration, optical illusion or use in composite form, whether intentional or otherwise, that may occur or be produced in the creation of the Images or in any subsequent use, processing or publication thereof; and (ii) any claim or cause of action, now known or later developed, resulting from or in connection with any use of the Images contemplated by this Release, including without limitation, any claims for libel, defamation, invasion of privacy, or breach of publicity or other property rights.

4. The person or persons signing this Release represent and covenant that: (i) if the Model is signing this Release, that he/she is of full legal age and has the right and capacity to contract in their own name in their jurisdiction of residence; (ii) if a parent or guardian is signing for the Model, that the person or persons signing have full authority in the jurisdiction in which the Release is executed to sign this Release on behalf of the Model; (iii) if acting as an employee of a company or other entity, the person or persons signing this Release have authority to bind the company or other entity; (iv) the person or persons signing this Release have carefully read the above Release prior to signing, and are fully familiar with the contents and consequences of it; and (v) this Release shall be binding without restriction as to time or otherwise upon the Model and his/her heirs, executors, legal representatives, successors and  assigns, as the case may be.

Notes: [insert particulars of consideration or other relevant information]

Photographer

Name (print) __________________________________________________ __
Date _____________________ *Signature___________________________
Phone____________________ Address ____________________________
City _________________ State/Province ______ Zip/Postal Code _________
Country ________________________Email: __________________________

Witness
(NOTE: All persons signing and witnessing must be of legal age and capacity in the area in which this Release is signed. A person cannot witness their own release)

Name (print) __________________________________________________ __
Date _____________________ *Signature___________________________

Model
Name (print) __________________________________________________ __
Date _____________________ *Signature___________________________
Phone____________________ Address ____________________________
City _________________ State/Province ______ Zip/Postal Code _________
Country ________________________Email: __________________________

Parent(s) or Guardian(s)
 (if person is a minor or lacks capacity in the jurisdiction of residence)

Name (print) __________________________________________________ __
Date _____________________ *Signature___________________________
Phone____________________ Address ____________________________
City _________________ State/Province ______ Zip/Postal Code _________
Country ________________________Email: __________________________