Model Release

Rx Images - Photography by Matt Hein                                                                                                                                                         

Photography Release Form

I ____________________________________________ (Name) grant to Rx Images ("Photographer") the absolute and irrevocable right and unrestricted permission concerning any photographs, videotape or digital recording that he/she has taken or may take of me or in which I may be included with others, to use, reuse, publish, and republish the photographs in whole or in part, individually or in connection with other material, in any and all media now or hereafter known, including the internet, and for any purpose whatsoever, specifically including sales, illustration, promotion, art, editorial, advertising, and trade, without restriction as to alteration; and I further consent that my name and identity may be revealed therein or by descriptive text or commentary in connection with any use if he/she so chooses.

I release and discharge Rx Images from any and all claims and demands that may arise out of or in connection with the use of the photographs, including without limitation any and all claims for libel or violation of any right of publicity or privacy. This authorization and release shall also inure to the benefit of the heirs, legal representatives, licensees, and assigns of Rx Images, as well as the person(s) for whom he/she took the photographs.

I do hereby release to Rx Images, its agents, and employees all rights to exhibit this work in print and electronic form publicly or privately and to market and sell copies. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used. I understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmission or playback.

I also understand that Rx Images is not responsible for any expense or liability incurred as a result of my participation in this recording, including medical expenses due to any sickness or injury incurred as a result.

I am a legally competent adult of at least 18 years of age, and have the right to contract in my own name (otherwise; see lower right portion). I have read this document and fully understand its contents. This release shall be binding upon me and my heirs, legal representatives, and assigns.

Name ___________________________________________

Address _________________________________________

Phone ___________________________________________

Witness for the undersigned ______________________

Signature & Date _________________________________

Guardian Release / If Model is under 18: I ______________________________________ , am the parent/legal guardian of the individual named above, I have read this release and approve of its terms.

Name ____________________________________________

Address __________________________________________

Phone ____________________________________________

Witness for the undersigned _______________________

Signature Date_____________________________________

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