I, _________________________________ (Henceforth known as "The Model") and I, Richard Taft (Henceforth known as "The Photographer") hereby agree to accept all conditions set forth in this limited consent and release.
I, the undersigned model, in consideration of _________ Dollars (_______), and other valuable considerations, receipt of which is acknowledged, do hereby give the undersigned photographer, his assigns, licensees, successors in interest, legal representatives, and heirs, the specific permission to: publish, copyright, distribute and/or display photographic images of me taken on the below listed date. The permission granted herein Limits the use of the photographs and negatives exposed on the date listed below, to the Photographers own self-promotion, and to promote and advertise his services and talents. I understand that this can be, but is not limited to posting of images on the Internet and via other public or private electronic mediums.
I, the undersigned model, grant the photographer usage rights for self-promotion use. I understand that I shall be due additional compensation at prevailing rates determined solely by the photographer should any of the photographs taken on this date be used for advertising or other commercial purposes within five years from the below date. I understand that this clause is null and void should I at any time within this five year period change my place of residence, mailing address, telephone number, or any other means of contact with me without informing the photographer of this change, in writing, and providing him with new and correct contact information. Any mail returned by the Post Office marked "Moved--No Forwarding Address", "Forwarding Order Expired" or similar notices shall be deemed as proof of nullification of this clause.
I, the undersigned model, testify that any and all photographs or negatives exposed on the date mentioned below can contain images of me nude or semi-nude or in other erotic situations, Including but not limited to images of me in bondage or restraint. I the Model testify that I am participating of my own free will and for my own entertainment, without any coercion or persuasion or threats from The Photographer or any outside parties.
I, the undersigned model, waive any right to inspect or approve the photograph(s) or finished version(s) incorporating the photograph(s), including written copy that may be created and appear in connection therewith.
I, the undersigned model, agree that the Photographer owns the copyright in these photographs and I hereby waive any claims I may have based on any usage of the photographs or work derived therefrom.
I, The Undersigned Photographer do grant to The Model the limited right to use for self promotion and advertisement of the models services and talents only, a limited number of photographs of the model taken on the below mentioned date. All Copyright information and logos, which the Photographer places on the photos, must remain as part of all images used by the model. This clause shall remain in effect in perpetuity, and can only be revoked with written consent from the photographer, irregardless whether the photographer changes address or location.
I, the undersigned model, hereby release and discharge the undersigned photographer, his clients and/or assigns, licensees, successors in interest, legal representatives, and heirs, from any and all liability including but not limited to claims for either invasion of privacy or libel, by virtue of distortion, blurring, alteration, optical illusion and/or use in composite form, whether the same is intentional, or otherwise.
I the undersigned model understand that the photographer, his clients or assigns, licensees, successors in interest, legal representatives, and heirs, may use any process or procedure resulting in the completion of the finished product, the publication, distribution, or public display, when photos of me are used in accordance with the usage restrictions listed above.
I the undersigned photographer understand that I am authorized to use the stage name ___________________________ in all public references to the model. I the photographer also understand that I am authorized to use the e-mail address of ____________________________________________________________ when providing contact information to the public.
By signing this limited consent and release form I, the undersigned model, represent that I am of legal age in the state in which this limited consent and release form is executed, that before signing this document, I have read it completely and understand it, and that I am bound, as is anyone who succeeds to my responsibilities and rights, as my heirs or assigns. I release the undersigned photographer and give up any and all future claims and rights, which I may have at any time.
MODEL'S SIGNATURE _________________ SESSION DATE ________
PHOTOGRAPHER'S SIGNATURE _________________________________
MODEL'S NAME (please print) ______________________________
MODEL'S ADDRESS _________________________________________
MODEL'S PHONE __________________________________________
MODEL'S DOB __________________