Model Release Form
I am aware of the fact that photos can be published if all the persons portrayed have given their consent.
I herewith declare, for all the enclosed photos, that
1. The photos are my personal property and/or I hold the rights thereto, particularly the right to publish them.
2. All the persons portrayed have given their written consent to publication of the photos.
3. All photos, images, graphics, and content become sole property of Cesar International (A.K.A. César International) and will not be returned.
For valuable consideration as listed below, I hereby give Cesar International, their legal representatives, and assigns, the right and permission to:
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 harmless Cesar International, their legal representatives, assigns, employees or any person or persons, corporation or corporations, acting under the permission of the photographer, including any firm publishing or distributing the finished product, even though the finished product may be distorted, blurred, altered, or used in composite form, either intentionally or otherwise and subject me to scandal, ridicule, reproach, scorn or indignity. I hereby waive any right to approve the finished photograph or any copy which might be used in conjunction with the finished photograph.
e) I hereby warrant that I am over eighteen years of age, and am competent to contract in my own name, insofar as the above is concerned or have a parent or guardian who can do so. I have read the above authorization, release and agreement, prior to execution; I fully understand the contents thereof. This agreement shall be binding upon me and my heirs, legal representatives and assigns.
Model’s Name (Please Print): ___________________________________
Street address: ______________________________ City: _____________________
State: _______________________ Zip ______________
Cellular Phone number ( ) _______________________ Landline Phone Number: ( ) ____________________
STATEMENT (please hand-write the paragraph "e" above
Signature of Model: _________________________________ Date: _______________
Witness Name: ______________________________________________________________
Signature of Witness: _______________________________ Date: _______________
(If the person signing is under 18, a parent or legal guardian must sign below.)
I hereby certify that I am the parent or legal guardian of the model named above and I give my consent without reservation to the foregoing on behalf of him or her.
Signature of Parent or Guardian: ___________________________ Date: ____________
Please take one or more good pictures of this signed document and send it by e-mail to:
CUSAint Gmail.com (please add @ to it)