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PHOTOGRAPHY MODEL RELEASE FORM For good and valuable consideration, receipt of which I hereby acknowledge, I specifically grant to Planned Parenthood of Central North Carolina, Inc. (PPCNC) and its respective subsidiaries, affiliates, successors and assigns, and to such other persons as PPCNC may designate from time to time (“Licensees”), the absolute and irrevocable right to take, use, publish, reproduce, distribute and/or copyright photographs, images and recordings of or including me, my name, voice and likeness, either still, motion picture or sound, for advertising, promotions and trade purposes in any and all publication and advertising media, in any manner in any media (including but not limited to print, audio, digital, electronic, broadcast, cable, satellite, etc.), whether now known or hereinafter invented, wherever and however they desire, in the United States or elsewhere in the world at any time in perpetuity. I agree that any pictures or images taken of me or sound recorded of me by the Licensees are owned by them, including any reproductions, derivatives or alterations thereof. If I should receive any photograph, image or recording from PPCNC, I shall not authorize its use by anyone else. Without limiting any of the foregoing, I (1) irrevocably consent to and authorize the reproduction, alteration and publication of such photographs, images or recordings, in whole or in part or in conjunction with other photographs, images, audio recordings and/or text, or in any altered or derivative forms, without any further compensation to me and (2) specifically waive any right to inspect or approve the final photography, images or recordings (or any derivatives or alterations thereof) that may be taken, used, published, reproduced, distributed or copyrighted hereunder. I specifically release PPCNC and all personnel associated with PPCNC of any and all liability to me and/or my property of any and every nature, including but not limited to any and all claims of defamation, privacy or publicity, arising out of any use or uses of my name, voice, likeness, photography, image or recording as contemplated herein. I further agree that I will not hold PPCNC, or anyone who receives permission from PPCNC, responsible for any liability resulting from the use of my name, voice, portrait, likeness, photograph(s), image(s) and/or recording(s) in accordance with the terms hereof, including what might be deemed to be misrepresentation of me, my character or my person due to distortion, optical illusion or faulty reproduction which may occur in the finished product. If I supply an already existing photograph, image or recording of myself to PPCNC, I grant the same unconditional and unlimited rights to PPCNC and make the same releases, representations, warranties and agreements with respect thereto as is set forth herein. I warrant and represent that this license does not in any way conflict with any existing commitment on my part. I certify that either (please check applicable box):
___ I am over 18 years of age and am under no legal or contractual disability to grant the rights and so forth above. ___ I am the parent of a guardian minor named below and grant the above rights and make the above releases, warranties, and statements on behalf of such minor and myself. Name (print): _________________________________________________________ Name of minor, if applicable (print): ______________________________________ Signature: ____________________________________________________________ Date: ________________________________________________________________
