MODEL RELEASE
COMPLETELY FILLED OUT AND SIGNED COPY MUST BE RETURNED TO:
KIDS HELPING KIDS • 229 Midland Avenue • Montclair, NJ 07042 • 974 783 0697
(To be used when photographs are taken and intended for the use in our newsletter, newspapers, etc.)
Event:______________________________________________________________Date:____
Location:____________________________________________________________________
For and in consideration of my engagement as a model/spokesperson/participant by Kids Helping Kids, Inc. (KHK), on terms or fee herein after stated, I hereby give KHK, it’s legal representatives and assigns, those for whom KHK is acting those acting with his permission, or his employees, the right and permission to copyright or use, reuse and/or publish, and republish or present photographic (still and/or live action) images, with or without my voice recorded, images of me, or in which I may be distorted in character, or form, in conjunction with my own or fictitious name, on reproduction, film, video tape or the like in color or black & white, made through any media by KHK in the studio or elsewhere, for any purpose what so ever; including the use of any printed matter or live action presentation in conjunction therewith.
I hereby waive any right to inspect or approve the finished photograph, videotape, film, printed matter or advertising copy that may be used in conjunction therewith or the eventual use that it might be applied.
I am familiar with the nature of the program and hereby release, discharge and agree to save harmless KHK, the photographer, “his” representatives, assigns, employees or any person or persons, corporation or corporations, acting under his permission or authority, or any person, persons, corporation or corporations, for whom he might be acting, including any firm publishing, presenting and/or distributing the finished product, in whole or in part, from and against any liability as a result of this presentation or any distortion, blurring, or alteration, optical illusion, or use in composite form, either intentionally or otherwise, that may occur or be produced in the taking, processing or reproduction of the finished product, its publication or distribution of
the same, even should the same subject me to ridicule. scandal, reproach, scorn or indignity.
I hereby warrant that I am under/over twenty-one years of age, and competent to contract in my own name insofar as the above is concerned.
I am to be compensated as follows: Zero Dollars
I have read the foregoing release, authorization and agreement before affixing my signature below, and warrant that I fully understand the contents thereof.
Signed:________________________________________
Name: _______________________________________
Address_______________________________________
_____________________________________________
Date: ________________
I hereby certify that I am the parent or guardian of_________________________________________________
a person under the age of twenty-one years and in consideration of value received, the receipt of which is hereby acknowledged, I hereby consent that any photographs, live action video tape, film or the like which have been or are about to be taken by KHK may be used by them for the purposes set forth in the original release here in above, signed by the person/model, with the same force and effect as if executed by me.
Signed:________________________________________
Name: _______________________________________
Address_______________________________________
_____________________________________________
Date: ________________
