Habenero Photography Model
Release
In consideration of my
engagement as a model, upon the terms herewith stated, I hereby give to
Richard
Henne his/her heirs, legal representatives and assigns, those for
whom Richard
Henne is acting, and those acting with his/her authority and
permission:
a) 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 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 Richard Henne,
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.
Dated: _____________________________________
Signed:_____________________________________
Address:____________________________________
City:_______________________________________
State/Zip:____________________________________
Phone:______________________________________
Witness:_____________________________________