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MODEL AGREEMENT RELEASE
Release #: _____________________________
Date/s of production/s: _____________________________
Model: _________________________________________
Address: ________________________________________
_______________________________________________
Phone No: ______________________________________
Model’s Age __________________


THIS MODEL AGREEMENT AND RELEASE (“Agreement”) is dated ___________ and is between the undersigned
photographer (“philip bolitho”) and the undersigned model/performer (“I”). Agreement as follows:
I hereby grant the undersigned Photographer permission to photograph me. I further give my irrevocable consent to Photographer and his/her direct or
indirect licensees and assignees to publish, republish or otherwise transmit the images of myself in any medium for all
purposes throughout the world. I understand that the images may be altered or modified in any manner. I hereby waive
any right that I may have to inspect and approve a finished product or the 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
and his/her direct or indirect licensees and assignees, from any claims for remuneration
Associated with any form of damage, foreseen or unforseen, associated with the use of the images.
I am of legal age and have the full legal capacity to execute this authorization without the consent or knowledge of any
other person.

AGREED BY THE MODEL/ PHOTOGRAPHER ______________________________________
__________________________________________
Photographer
Signature Signature
Print Name: Philip Bolitho . A1 Capture.com


Model
Print Name:_________________________________
Date: __________________________________


Address:___________________________________
Model Release Agreement