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

MODEL RELEASE FORM

Under 18 years of age - Minor

In consideration of the engagement as a model the minor named below, and for other good and valuable consideration, receipt of which is hereby acknowledged, I the undersigned parent/guardian of the minor model mentioned below (“Model”), hereby grant the undersigned photographer ("Photographer") , his/her legal representatives and successors, as well as persons and companies, including Loma Linda Photo Portrait Studio, acting with his/her permission, the irrevocable right and permission, throughout the world, to take, use, reuse, publish, and republish photographic portraits or pictures of the minor or in which the minor may be included, in whole or in part, or composite or distorted in character or form, without restriction as to changes or alterations from time to time, in conjunction with the minor’s own or a fictitious name, or reproductions thereof in color or otherwise, made through any medium at his/her studios or elsewhere, and in any and all media now or hereafter known, for art, advertising, trade, or any other purpose whatsoever, as well as using my name in connection therewith.  I also consent to the use of any published matter in conjunction thereof.

I waive the right to inspect or approve the finished product or copy and any use thereof.

I agree that the photographs, reproductions, and negatives thereof shall constitute the photographer's sole property, and that the photographer has the full right to dispose of any or all of them in any manner whatsoever.

I hereby forever release and discharge Photographer and his/her respective representatives, licensees, successors and assigns, specifically Loma Linda Photo Portrait Studio and its clients, from any and all claims, actions and demands arising out of or in connection with the use of said photographs, including, without limitation, any and all claims for invasion of privacy and libel.

I acknowledge that this release document was signed by me willingly and I certify that I am the parent/guardian of the Model mentioned below, and I consent to the above statements on his/her behalf.

Model’s name: ____________________________________________________________

Model’s parent or guardian’s name: ____________________________________________

Parent or guardian’s signature: __________________________________Date: _________

Model’s parent or guardian’s address: __________________________________________

Model’s parent or guardian’s phone: ___________________________________________

Model’s parent or guardian’s e-mail address: _____________________________________

Photographer’s Name: _______________________________________________________

Photographer’s Signature: ______________________________ Date: _______________

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