Loma Linda Photo Portrait Studio
10529 Anderson St.
Loma Linda, CA 92354
909-796-6458

MODEL RELEASE FORM - ADULT

In valuable and good consideration of my engagement as a model (Participant), upon the terms herewith stated, I hereby give to David White (the Photographer), his/her heirs, legal representatives and assigns, those for whom The Photographer is acting, and those acting with his authority and permission:

a) The unrestricted right and permission forever to copyright and use, re- use, publish, and republish photographic portraits or pictures of me or in which I may be included intact or in part, composite or distorted in character or form, without restriction as to changes or transformations in conjunction with my own or a fictitious name, or reproduction hereof in color or otherwise, made through any and all media now or hereafter known for illustration, art, promotion, advertising, trade, or any other purpose whatsoever.

b) I also permit the use of any text material in connection therewith.

c) I hereby relinquish any right that I may have to examine or approve the completed product or products or the advertising copy or printed matter that may be used in conjunction therewith or the use to which it may be applied.

d) I hereby release, discharge and agree to save harmless the Photographer, his/her heirs, legal representatives or assigns, and all persons functioning under his/her permission or authority, or those for whom he/she is functioning, from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form whether intentional or otherwise, that may occur or be produced in the taking of said picture or in any subsequent processing thereof, as well as any publication thereof, including without limitation any claims for libel or invasion of privacy.

e) I hereby affirm that I am over the age of majority and have the right to contract in my own name. I have read the above authorization, release and agreement, prior to its execution; I fully understand the contents thereof. This agreement shall be binding upon me and my heirs, legal representatives and assigns.

I am also aware that these terms are subject to negotiation, deletion or addendum, which may be valid if handwritten on this release and initialed and dated by both parties (The Photographer and Undersigned) next to the modification or any modification that is typed and signed by both parties. Modifications may be implied by any releases/contracts with my employer without my notice by the Photographer.

______________________________                        ______________________________
Name of Participant                                                                             Address

______________________________                        ______________________________
Signature of Participant                                                                      Address

______________________________                        ______________________________
Signature of Photographer                                                                 Phone number or e-mail

Date Signed: ____/____/____

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