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MODEL RELEASE FORM
This Model Release Form relates to the following photographs and/or images (the "Work"):
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I, ________, of legal age, with address at ________, consent, agree and authorize ________, of legal age, and with address at ________ (the "Publisher"), together with any officers, employees, directors, agents, contractors, assignees, licensees, transferees, successors, legal representatives, or other representatives of the Publisher (the "Publisher's Representatives"), to use, publish, reuse, republish, distribute, disseminate, or otherwise make publicly available the Work for any lawful use that the Publisher or any of the Publisher's Representatives determine in their absolute discretion, including the use of my name without restriction. The Publisher shall also be specifically permitted to use fictitious names in conjunction with the Work.
This authorization and release shall inure to the benefit of the legal representatives, licensees, heirs, and assigns of the Publisher and shall be binding upon me, my heirs, assignees, and legal representatives.
Signed this day of ______ day of _____________________, 20______ at the City/Municipality of _____________________, Province of _____________________.
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Model
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