Релиз модели для несовершеннолетних на английском

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Model Release for MINOR
Fo r go od and valuab le consideration, the r ece ipt and
l egal sufciency of w hich is here b y acknow ledged,
I ________________________________________________ (“Model”)
her eby grant to ____________________________________________
and SHUTTERSTOCK, INC. (collectively , the “Photographer”),
the Photographer’ s assigns, and those persons acting with the Photographer’s
authority and permission, the right to take and cr eate photographs/videos
and other still and/or moving images, (in all formats) and other
graphical depictions incorporating my likeness, in any and all media,
whether now known or her eafter created (the “Content”).
I her eby agr ee that all rights in and to the Content, including the copyright,
ar e and shall r emain the sole pr operty of the Photographer , free and clear
fr om any claims by me or anyone acting on my behalf.
The Photographer’ s rights include, but ar e not limited to, the rights,
in perpetuity , to:
Use, r e-use, publish, and r e-publish the Content; Alter , modify or otherwise
change the Content in any manner the Photographer desir es; Combine the
Content with textual matter and/or with other pictur es and/or media; and,
Use the Content for illustration, pr omotion, art, editorial, adver tising, trade,
publishing, or any other purpose whatsoever .
I her eby r elease, dischar ge, and agree to hold harmless the Photographer,
the Photographer’ s heirs, legal representatives and assigns, and all
persons acting under the Photographer’ s authority or those for whom he/
she is acting, fr om any liability by vir tue of any use of the Content or any
changes or alterations made ther eto.
I warrant and r epresent that I am the father/mother/guar dian ( c ir c le on e) of
______________________________________________, the Model above
named. I have r ead the above authorization, r elease and agreement,
prior to its execution, and I am fully familiar with the contents ther eof.
This r elease shall be binding upon me and my heirs, legal r epresentatives
and assigns.
Photographer Information:
Name (Print): ___________________________________________________
Addr ess: ______________________________________________________
City: ____________________________ State: ________________________
Country: ___________________________ Zip/Postal Code: _____________
Phone: ________________________ Email: __________________________
Date of Shoot: ________________________ Medium: Still
V ideo
Signatur e: _____________________________________________________
350 5th Avenue . 21st Floor . N ew York . N ew Y o rk 10118
866. 663. 3954(p) 347. 402. 0710(f) www .Shu tte rs tock.com
Model Information:
Name (Print): ________________________________________________
Addr ess: ____________________________________________________
City: __________________________ State: ________________________
Country: _______________________ Zip/Postal Code: _____________
Phone: __________________ Email: ______________________________
Date of Bir th: _________________________________________________
Signatur e of Par ent/Guar dian (if minor): ____________________________
Date: _______________________________________________________
Description of Scene: __________________________________________
Model Ethnicity (Optional):
___ Asian ___ African-American
___ Black ___ Caucasian (White)
___ Eur opean ___ Hispanic (Latin)
___ Middle Eastern ___ Native American
___ Pacic Islander ___ Mixed Race
___ Other: _____________________________________________
Visual Refer ence
(Optional headshot or other r eference may be included her e.
Nude imagery r equires a driver license)
Name (Print): _________________________________________________
Signatur e: ___________________________________________________
Date: ______________________________________________________
Rev . 10/2012