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a stranger, 365

Model Consent and Release


[PHOTOGRAPHER IMAGE ID(S): ________________________________________]
Preamble
Its pretty simple: Im taking photos of someone I dont know every day for a year and publishing them
online. Im really happy to meet you and take your photo!
Model Consent and Release:
For good and valuable consideration received, I hereby irrevocably consent to and authorize the use by
Matthew A. Roth (hereafter Photographer) and his affiliates, assignees and licensees throughout the
world, of any and all (a) picture and/or sound material of myself taped by or for the Photographer, and/or
(b) any images, photographs, video clips or other elements photographed by or for the Photographer
(collectively, the Material)), and any reproductions of them in any form, in any media whatsoever for
any purpose (except pornographic or defamatory) which may include, advertising and packaging for any
product or service.
I also consent to the use of my own name or any fictitious name, which may be chosen in connection
with the Material. I hereby (a) waive any right to inspect or approve the Material or the use to which the
Material may be applied; and (b) release any and all claims whatsoever in connection with the use of the
Material.
I represent and warrant that I am at least 18 years of age and have the full legal capacity to execute this
Model Consent and Release. I state further that I have read the above authorization, release and
agreement, prior to its execution, and that I am fully familiar with the contents thereof.
I certify that this Model Consent and Release constitutes the sole, complete, and exclusive agreement
between Photographer and me regarding the Material; I am not relying on any other oral or written
representation.
Model Information
Signature/Date Signed __________________________________________________________
Name (print)

_________________________________________________________

E-Mail _____________________________________________
If Model is not yet eighteen (18) years old, complete the following:
I, the undersigned, hereby warrant that I am the parent or legal guardian of the above named model, a
minor, and have full authority to authorize the above Release, which I have read and approved. I hereby
release and agree to indemnify the licensed parties and their respective successors and assigns, from
and against any and all liability arising out of the exercise of the rights granted by the above release.
Parent/Legal Guardian Information
Signature/Date Signed _____________________________________________________________
Parent/Guardian Name (print) __________________________________________________________
E-Mail _______________________________________________

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