ADULT MODEL / PERFORMER AGREEMENT RELEASE

Model: _________________________________________

Address: _______________________________________

_______________________________________________

_______________________________________________

Phone No: ______________________________________

Email: __________________________________________

Model’s Age (at time of production): _______________________

Description of production/s: ________________________________

____________________________________________________________

___________________________________________________________

THIS MODEL AGREEMENT AND RELEASE (“Agreement”) is dated ___________ and is

between the undersigned photographer (“Photographer”) and the undersigned model /
performer (“I”). Agreement as follows:
For good and valuable consideration of ___________________________________ I hereby
grant the undersigned Photographer permission to photograph me. I further give my
irrevocable consent to Photographer and his direct or indirect licensees and assignees to
publish, republish or otherwise transmit the images of myself in any medium for all purposes
(except pornographic, defamatory, libellous or otherwise unlawful) throughout the world which
may include, among others, advertising, promotion, marketing and packaging for any product
or service. I agree that the images may be combined with other images, text and graphics,
and cropped, altered or modified in any way.
I agree that I have no rights to the Images, and all rights to the images belong to the
Photographer and his assignees and licensees. I acknowledge and agree that I have no
further right to additional consideration or accounting, and that I will make no further claim for
any reason to Photographer and/or assignees/licensees. I acknowledge and agree that this
release is binding upon my heirs and assignees. 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/PERFORMER PHOTOGRAPHER

______________________________________ __________________________________________
Signature Signature

______________________________________ __________________________________________

Print Name:_____________________________ Print Name:_________________________________

Date: __________________________________ Address:___________________________________