Photo Permission Form LifeSpan Release Of consideration of my

Photo Permission Form
LifeSpan Release
Of consideration of my engagement as a model, and for other good and valuable
consideration herein acknowledged as received, I hereby grant to LifeQuest, his/her heirs
legal representatives and assigns, those for whom Photographer is acting, and those
acting with his authority, and permission the irrevocable and unrestricted right and
permission to take, copyright in his own name or otherwise, and use, reuse and republish
photographic portraits or pictures of me or in which I may be included in whole or part,
or composite or distorted in character or form without restriction as to changes or
alterations, in conjunction with my own or a fictitious name, or reproductions thereof in
color or otherwise, made through any medium at his studios or elsewhere, and in any or
all media now or hereafter known for illustration, promotion, art editorial, advertising,
trade, stock sales, or any other purpose whatsoever, without further compensation. I also
consent to the use of any published matter in conjunction 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 conjunction
therewith or the use to which it may be applied.
I hereby release, discharge and release LifeQuest, his/her heirs, legal representatives and
assigns, and all persons acting under his permission or authority or those for whom he is
acting, 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 photograph or in any subsequent processing thereof, as
well as any publication thereof, including without limitations any claims for libel or
invasion of privacy.
I hereby warrant that I am of legal age and have the right to contract in my name. I have
read the above authorization, release, and agreement, prior to its execution, and am fully
familiar with the contents thereof. This release shall be binding upon me and my heirs,
legal representatives, and assigns.
I Agree
I Disagree
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Child’s Name
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Date
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Parent/Guardian Name
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Parent/Guardian Signature
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Witness