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Jeff Stelk
1782 Evergreen Ct • Custer, WI • 54423
[email protected] • jeffstelk.com • 715.630.8205
Model Release Form Model/Client Details Full Name: _______________________________________________________________ Address:
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City: ________________ State: _________________ Zip: _________________________ Home Phone: _________________________ Cell Phone: __________________________ Email:
_______________________________________________________________
Shoot Location:
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Date:
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I understand that the photographs taken of me during this session can be used wholly or in part in magazines, books, calendars, portfolios, exhibition and for internet, editorial, advertising or educational use. The photographs may be used to represent an imaginary person and any wording associated will not be attributed to me personally unless my name is used. I acknowledge that by signing this form, I give up all claims of ownership, income, editorial control and use of the resulting photographs unless a valid licensing agreement has been purchased from Jeff Stelk, and assign all copyright ownership to the photographer. Use of the photographs may be granted to third parties, however the photographs will remain the property of Jeff Stelk. I have read this form carefully and fully understand its meanings and implications. I acknowledge that by signing this form I give Jeff Stelk full copyright and authority to publish the photographs, and my agreement to the terms listed above. Signed: _____________________________________ Date: ________________________ If the model/client is under 18 years of age, a parent or legal guardian must also sign here: Parent/Guardian: __________________________________________ Date: _____________ Address: ___________________________________________________________________
