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Adult Release Form

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Wisiso
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© © All Rights Reserved
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31 views3 pages

Adult Release Form

Uploaded by

Wisiso
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Release Form

For and in consideration of my engagement as a model by the videographer, and moneys paid or to
be paid to me by the videographer, and in further consideration of the publicity to be received by
the undersigned by the use of such videos, I hereby give the videographer, his representatives and
assigns, those acting with his permission, and their representative agents and employees, and any
other publisher (herein collectively referred to as the "Users"),who may hereafter publish the films
or videos, the absolute right and permission to
copyright,use,reuse,publish,republish,exhibit,display,print and reprint in advertising
materials,television and motion pictures,magazines,books,and other media,and for any other
purpose as they may see fit,in their sole and absolute discretion,the films,videos,negatives,prints or
every kind and nature,illustrations,portraits made from the videos,pictures,designs,paintings and
drawings of every kind and nature heretofore taken,or taken this day,or hereafter taken by the
photographer (herein collectively referred to as the "Videos"),including,without
limitation,reproductions thereof in which I may be included in whole or in part. Such Videos may be
used in any way by the Users for purpose of trade,advertising,publicity or promotion or any kind
without restriction. The failure of the videographer to pay for such use shall not be deemed as a
failure of consideration by any of the Users.

I hereby waive any right to inspect or approve the Videos or the editorial or advertising copy or
printed matter that may be used by the Users in conjunction therewith. I further waive any claim
that I may have to the eventual use to which it may be applied. Such Videos may be used with or
without my name,or any fictitious name,and with fictitious or actual quotations,interviews,or
biographical material. The Users may use such Videos and accurate or fictitious statements
attributed to me which may constitute endorsement of service or products,in the sole discretion of
the Users.

I hereby release,discharge,and agree to save harmless the Users from and against any and all liability
in connection with the use of such Videos,even should the same subject me to
ridicule,scandal,reproach,scorn,or indignity,and from any liability as a result of any
distortion,blurring or alteration,optical illusion or use in composite form,either intentionally or
otherwise,that may occur or be reproduced in the taking,processing or reproduction of the finished
product,or its publication or distribution. I waive any claim that I may have for alleged violation of
privacy,defamation or libel by the use of such Videos.

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I hereby represent that I am over the age of 18 years and have read this authorization and release
prior to its execution. I have not been induced to sign the same other than by recited
considerations,by any statement made by the videographer or his agents,employees,or anyone
acting on his behalf. My signature below is acknowledgement that the identification that appears
below is true and accurate. World rights and multiple usage of the Videos is hereby authorized.

Model's Name:___________________________________________

Model's Address:________________________________________

Model's City/State/Zip:_________________________________

Model's Telephone Number:_______________________________

Model's National Identity Number:_________________________

Model's Birth Date & Age:_______________________________

Model's Stage Name:_____________________________________

Model's Signature & Date:_______________________________

Videographer:___________________________________________

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Address:________________________________________________

City/State/Zip:_________________________________________

Telephone:______________________________________________

Social Security Number:_________________________________

Videographer's Signature & Date:________________________

Page 3 of 3

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