Model Release
Mother's Name
Mother's Name
*
First
Last
Father's Name
Father's Name
First
Last
Address
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
United States
United Kingdom
Canada
Australia
Netherlands
France
Germany
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Afghanistan
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Mali
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Nigeria
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Vietnam
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Country
Email
*
Phone (cell preferred)
*
Model Release Agreement
Minor Model Name (baby or child)
Model Release Agreement
Minor Model Name (baby or child)
*
First
Last
Minor Model Date of Birth
*
Additional Model name (mother if in photos)
Additional Model name (mother if in photos)
First
Last
Additional Model name (father if in photos)
Additional Model name (father if in photos)
First
Last
Additional minor model names and ages (siblings)
I, the client, give Chelsea Lietz permission to photograph the minor(s) described herein. I warrant that I am the parent or legal guardian of the minor(s) and have full right and authority to grant this consent on behalf of such minor(s).
I, authorize the Photographer to use and to create images for promotional material, online usage, and other areas of marketability. I further authorize the distribution of photographs to potential clients of the Photographer for portfolio purposes.
I, further acknowledge that I will not be compensated, either now or at any time in the future, for any use of marketing and that the Photographer of such photos exclusively owns all rights.
I, also hereby waive all rights and release the photographer from, and shall neither sue nor bring any proceeding against the photographer or his agents for any claim or cause of action, whether now known or unknown, for defamation, invasion of right to privacy or personality or any similar matter based upon or relating to the use and exploitation of the photos.
I also consent to the use of the minor’s own name or any fictitious name which may be chosen in connection with the aforesaid photographs.
I hereby release any and all claims whatsoever in connection with the use of the minor’s photograph and name and the reproduction thereof as aforesaid.
I hereby waive any right that I may have to inspect and/or approve the photographs or any advertising copy that may be used in connection therewith or the use to which it may be applied.
I agree that I have read and understood the contents hereof, and that I have the right and authority to execute this release.
If you have any questions at all please email me at info@ChelseaLietzPhotography.com *before* completing this release.
Type: I agree.
*
*
I hereby acknowledge and represent that I am over the age of 18 years and that I have read and understand this release.
I hereby acknowledge and represent that the subject is a minor and that I am the parent or duly authorized representative of the subject and that I have read and understand the release.
I understand that it is illegal to copy or reproduce these photographs elsewhere without the photographer’s written permission and violators of this Federal Law will be subject to civil and criminal penalties. All images are copyrighted Chelsea Lietz Photography
Signed on this date
Signed on this date
*
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MM
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Draw your signature into the box below.
*
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or
Type
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Full Name
I understand this is a legal representation of my signature.