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and permission with respect to the photographs Photographer has taken of me or in which I may be included with others to: (a) copyright the same in his or her own name or any other name he or she may select. (b) use, reuse, publish, and republish the same, whole or in part, separately or in conjunction with other photographs in any and all media now and hereafter known for r illustration, art, promotion, advertising, trade, editorial, or any purpose whatsoever, without restriction as to alteration. (c) use my name in conjunction therewith if he or she so decides. I hereby release and discharge Photographer form any and all claims and demands arising out of or in connection with the use of the photographs, including any and all claims for libel or invasion of privacy. This authorization and release shall also inure to the benefit of the heirs, legal representatives, licenses, and assigns for the Photographer, as well as the person(s) for whom he or she took the photographs. I have read the foregoing prior to its execution, and I fully understand the contents of hereof. I hereby affirm that I am of full age. I represent that I am the parent/guardian of the minor model named herein and have every right to contract for the minor model in the above regard. For value received I herby consent to the foregoing on his/her behalf. This agreement shall be binding upon me and my heirs, legal representatives and assigns. Date:_____________ Minor's Name:____________________ Parent or Guardian:____________________ Address:_____________________________ _____________________________ _____________________________ Witness: ________________________