Model Release Form for a Minor or Child

In consideration of my engagement as a model of the minor named below, and for other good and valuable consideration herein acknowledged as received, I hereby grant the following rights and permissions to __________________________ ("Photographer"), his/her heirs representatives, and assigns, those for whom the Photographer is acting and those acting with his/her authority and permission. They have the irrevocable, perpetual and unrestricted right and permission to take, use, re-use, publish, and republish photographic portraits or pictures of the minor or in which the minor may be included, in whole or in part, or composite or distorted in character or form, without restriction as to changes or alterations, in conjunction with the minor’s own or a fictitious name, or reproductions thereof in colour or otherwise, made through any medium at his/her studios or elsewhere, and in any and all media now or hereafter known, specifically including but not limited to print media and distribution over the internet for illustration, promotion, art, editorial, advertising, trade, or any other purpose whatsoever.

I specifically consent to the digital compositing or distortion of the portraits or pictures, including without restriction any changes or alterations as to colour, size, shape, perspective, context, foreground or background. I also consent to the use of any published matter in conjunction with such photographs. I hereby waive any right that I or the minor may have to inspect or approve the finished product or products and the advertising copy or other matter that may be used in connection with them or the use to which they may be applied. I hereby release, discharge, and agree to hold harmless Photographer, his/her heirs, legal representatives, and assigns, and all persons acting under his/her permission or authority or those for who he/she 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 such photographs or in any subsequent processing of them, as well as any publication of them, including without limitation and claims for libel or violation of any right of publicity or privacy.

I hereby warrant that I am a legal competent adult and a parent or legally appointed guardian of the minor in the above regard. I state further that I have read the above authorisation, release, and agreement, prior to its execution, and I am fully familiar with he contents of this document. This document shall be binding upon the minor and me, and our respective heirs, legal representatives, and assigns.

Legal guardian's signature

Minor's signature (if over 14 yrs)

Legal guardian's name

Minor's printed name

Minor's date of birth

Address

Address

Guardian's email address

Today's date

Witness signature

Witness name

Address

Address

Today's date