| Permission for Photography |
| Signed Model Release |
Permission for Photography
For valuable consideration received, I grant to Ema Drouillard ("Photographer") the
absolute and irrevocable right and unrestricted permission concerning any photographs
that she has taken or may take of me or in which I may be included with others, to use,
reuse, publish, and republish the photographs in whole or in part, individually or in
connection with other material, in any and all media now or hereafter known, including the
internet, and for any purpose whatsoever, specifically including illustration, promotion,
art, editorial, advertising, and trade, without restriction as to alteration; and to use my
name in connection with any use if she so chooses. I release and discharge Photographer
from any and all claims and demands that may arise out of or in connection with the use of
the photographs, including without limitation any and all claims for libel or violation of any
right of publicity or privacy. This authorization and release shall also insure to the benefit
of the heirs, legal representatives, licensees, and assigns of Photographer, as well as the
person(s) for whom she took the photographs. I am a legally competent adult and have the
right to contract in my own name. I have read this document and fully understand its
contents. This release shall be binding upon me and my heirs, legal representatives, and
assigns.
X
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SIGNATURE (SEAL)
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PRINT NAME
--------------------------------------------------------------------------------
DATE
--------------------------------------------------------------------------------
PHONE NUMBER
-------------------------------------------------------------------------------
STREET ADDRESS
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CITY, STATE, ZIP
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EMAIL ADDRESS
X
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IF MINOR, SIGNATURE OF PARENT/GUARDIAN
X
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SIGNATURE OF WITNESS
--------------------------------------------------------------------------------
WITNESS (Print Name)
A release is required for each person in the photo.
Once signed please mail to: Ema Drouillard, 1 Dove Place, Novato, CA 94949
Or scan and email to 2ema@comcast.net
For valuable consideration received, I grant to Ema Drouillard ("Photographer") the
absolute and irrevocable right and unrestricted permission concerning any photographs
that she has taken or may take of me or in which I may be included with others, to use,
reuse, publish, and republish the photographs in whole or in part, individually or in
connection with other material, in any and all media now or hereafter known, including the
internet, and for any purpose whatsoever, specifically including illustration, promotion,
art, editorial, advertising, and trade, without restriction as to alteration; and to use my
name in connection with any use if she so chooses. I release and discharge Photographer
from any and all claims and demands that may arise out of or in connection with the use of
the photographs, including without limitation any and all claims for libel or violation of any
right of publicity or privacy. This authorization and release shall also insure to the benefit
of the heirs, legal representatives, licensees, and assigns of Photographer, as well as the
person(s) for whom she took the photographs. I am a legally competent adult and have the
right to contract in my own name. I have read this document and fully understand its
contents. This release shall be binding upon me and my heirs, legal representatives, and
assigns.
X
--------------------------------------------------------------------------------
SIGNATURE (SEAL)
--------------------------------------------------------------------------------
PRINT NAME
--------------------------------------------------------------------------------
DATE
--------------------------------------------------------------------------------
PHONE NUMBER
-------------------------------------------------------------------------------
STREET ADDRESS
--------------------------------------------------------------------------------
CITY, STATE, ZIP
--------------------------------------------------------------------------------
EMAIL ADDRESS
X
--------------------------------------------------------------------------------
IF MINOR, SIGNATURE OF PARENT/GUARDIAN
X
--------------------------------------------------------------------------------
SIGNATURE OF WITNESS
--------------------------------------------------------------------------------
WITNESS (Print Name)
A release is required for each person in the photo.
Once signed please mail to: Ema Drouillard, 1 Dove Place, Novato, CA 94949
Or scan and email to 2ema@comcast.net
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