Indiana Model Release Form

Indiana State University Model Release Form
For good and valuable consideration, the receipt and sufficiency of which is hereby
acknowledged, I
hereby grant Indiana State University, its employees, legal representatives, and assigns, those for
whom ISU is acting and those acting with ISU’s authority and permission, the irrevocable and
unrestricted right and permission to copyright in ISU’s name or otherwise, and use; publish, and
republish photographic portraits, images or video of ______________________________(model
name) in whole or in part, as part of a composite or distorted in character or form, without
restriction as to the changes or alterations, in conjunction with my own or a fictitious name, or
reproductions in color or otherwise made through any medium, and in any and all media now or
hereafter known for illustration, promotion, art, editorial, advertising, trade, publishing, or any
other purpose whatsoever. I also consent to the use of any printed matter or video in connection
therewith.
I hereby waive any right that I may have to inspect or approve the finished product or products
and the advertising copy or other matter that may be used in connection therewith or the use to
which it may be applied.
I hereby release, discharge, and agree to save harmless Indiana State University, its employees,
legal representatives and assigns, and all person acting under ISU’s permission or authority 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 such
photographic portraits, images or video in any subsequent processing thereof, as well as any
publication thereof, including without limitation and claims for libel or invasion of privacy.
I hereby warrant that I am of full legal age and have the right to contract in my own name. I
have read the above authorization, release, and agreement, prior to its execution, and I am fully
familiar with the contents thereof. This release shall be binding upon ISU, its employees, legal
representatives and assigns.
MODEL_____________________________________________________
____
NAME (PRINT)_______________________________ DATE_____________________
SIGNATURE_________________________________
PHONE____________________
ADDRESS____________________________________
CITY_______________________ STATE_________________ ZIP____________
E-MAIL___________________________
Parent or Guardian (if under 18 years of age)___
NAME (PRINT)____________________________
SIGNATURE ______________________________
WITNESS (NOTE: Must be of legal age)_______
NAME (PRINT) _____________________________
SIGNATURE________________________________