Promo Chicks

Adult Model Release



I, _______________________________________, for good and valuable consideration, the receipt of which is acknowledged, give to Patrick N. Thielen (Photographer), his legal representatives, successors, and all persons or corporations acting with his permission, unrestricted permission to copyright and/or use, and/or publish photographic portraits or pictures of me, and the negatives, transparencies, prints, or digital information pertaining to them, in still, single, multiple, moving or video format, or in which I may be included in whole or part, or composite, or distorted in form, or reproductions thereof, in co lour or otherwise, made through any media in his studio or elsewhere for art, or any lawful purpose.

I hereby waive any right that I may have to inspect and approve the finished product or copy that may be used in connection with an image that the Photographer has taken of me, or the use to which it may be applied.

I further release the Photographer, or others for whom he is acting, from any claims for remuneration associated with any damage, foreseen or unforeseen, associated with the proper commercial or artistic use of these images unless it can be shown that said reproduction was maliciously caused, produced and published for the sole purpose of subjecting me to conspicuous ridicule, scandal, reproach, scorn and indignity.

I agree that, while I may use the photographs for purposes related to the non-commercial promotion of my modeling business, including but not limited to portfolios, composite cards, exhibitions, contests and promotional internet web sites, I will not sell or use any of the photographs for any commercial purpose. Furthermore, I agree to credit the photographer, including copyright notice, whenever an image is reproduced.

I acknowledge that the photography session was conducted in a completely proper and highly professional manner, and this release was willingly signed at its termination. I certify that I am not a minor, and am free and able to give such consent.



Negative Set Number: ______________ Date of Photo Session: _________________

Photo Session Description: ________________________________________________

Dated: ________________ Phone: ______________________________

Name: __________________________ Signed: ______________________________

Address: ________________________ City: ________________________________

State/Zip: ________________________ E-Mail: ______________________________



Witness:

Name: __________________________ Signed: ______________________________

Address: ________________________ City: ________________________________

State/Zip: ________________________ Phone: ______________________________

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