Model Release Form

Effective as of the date shown below, approval for past use and permission for present and future use is
being granted to Damon James Media, 8720 Matthews Farm Ln Apt 11116, Charlotte, North Carolina 28277
to use photographs or other images taken on _________________ of _________________ (the
Photographed Party), as more fully explained in this Consent and Release. The Photographed Party is an
adult and is fully authorized to sign this Consent and Release.
For value received, receipt of which is hereby acknowledged, the Photographed Party hereby grants consent
to Damon James Media, its agents, employees, licensees, and successors in interest (collectively, the
Released Party) and authorizes the use of any and all photographs taken of the Photographed Party, and any
reproduction of them in any form in any media whatsoever and in any derivative work based thereon
throughout the world, and to use them to publicize, promote and advertise, including but not limited to use
for point of sale advertising.
The Photographed Party also consents to the use of their own name or any fictitious name which may be
chosen in connection with the aforesaid photographs.
The Photographed Party hereby releases any and all claims whatsoever in connection with the use of their
photograph and name and the reproduction thereof as aforesaid.
The Photographed Party hereby waives any right that they may have to inspect and/or approve the Book or
the advertising copy that may be used in connection therewith or the use to which it may be applied.
THE PHOTOGRAPHED PARTY WARRANTS THAT THEY ARE THE UNDERSIGNED AND THAT
THEY HAVE READ THIS CONSENT AND RELEASE PRIOR TO THE SIGNING OF THIS
DOCUMENT, THAT THE UNDERSIGNED UNDERSTANDS IT, AND THAT THE UNDERSIGNED
FREELY ENTERS INTO THIS CONSENT AND RELEASE.
Signed by _________________ of _________________, _________________, _________________
_________________ with the intent of being legally bound on _________________