Model release form

The undersigned model and photographer hereby agree to accept all conditions set forth in this limited consent and release.
I, the undersigned model, hereby give the undersigned photographer, his clients and/or assigns, specific permission to: publish, copyright, distribute and/or display photographic images of me taken on the below listed date. The permission granted herein is strictly limited to the uses described below and for no other purposes, whether suggested or implied.
I, the undersigned photographer, agree that the model has the right to inspect and/or examine all photographs and/or written text to which the images may be applied before use as described below.
I, the undersigned model, hereby release and discharge the undersigned photographer, his clients and/or assigns from any and all liability by virtue of distortion, blurring, alteration, optical illusion and/or use in composite form, whether the same is intentional, or otherwise. I understand that the photographer, his clients or assigns 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 listed below.

USAGE________________________________________________________________________

______________________________________________________________________________

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 that I may have at any time.

MODEL'S SIGNATURE ___________________________ SESSION DATE __________________

PHOTOGRAPHER'S SIGNATURE _______________________________________________

WITNESS __________________________________________________________________

MODEL'S NAME (please print) _________________________________________________

MODEL'S ADDRESS _________________________________________________________

MODEL'S PHONE ____________________________________________________________

I have inspected and examined the photographs and/or written text in accordance with the above agreement.

MODEL'S SIGNATURE ____________________________ DATE _______________

I waive the right to inspect and/or examine the photographs and/or written text.

MODEL'S SIGNATURE ____________________________ DATE _______________