DANCE PHOTOGRAPHY

MODEL RELEASE FORM

Photographer: Karin Shugrue

For consideration herein acknowledged as received, I hereby grant the above named photographer, all licensees and assignees the unrestricted right to copyright, publish and use photograph(s) of me and any other reproductions or adaptations thereof, in whole or in part, without restrictions as to changes or alterations, in any media for advertising, art and exhibition, editorial or any other purpose whatsoever.

I understand that unless I agree that my name is published, used or referred to in connection with the photograph(s), the photograph(s) or words published with them will not be attributed to me personally.

I hereby release and discharge the above named photographer, all licenses and assignees from any liability whatsoever, by reason of any alteration or use in composite or in any other form, whether intentional or otherwise, that may occur in any publication, sale or use of the photograph(s).

I warrant that I am over the age of majority* and have read this release and understand its contents.  This release shall be binding upon me, my heirs and assignees.

I am the parent or guardian of

and consent to these conditions.

Model’s Name

Address

Telephone

Signature of Model/Parent/Guardian  

Date

Signature of Photographer   

Date