Model Release Agreement for a Minor

The parties to this release agreement are: Names: _______________________________________________________________ Telephone Number and Email Address: ______________________________________ (Hereinafter referred to as "the Parent/Guardian" and contracting on behalf of the named belo!" inor

Names: _______________________________________________________________ (Hereinafter referred to as "the odel"" AN#

Full Legal Name & Business: Natasha $ueen %latter& ' $ueen %latter& Photograph& Telephone Number and Email Address: ()*+,-.+/)/* $ueen%latter&Photograph&0gmail1com (Hereinafter referred to as "the Photographer"" 2hereas for 3aluable consideration hereb& ac4no!ledged as recei3ed5 the Parent/Guardian on behalf of the odel granted the Photographer permission to photograph and/or film and sound record the odel and furthermore grant permission to use the resulting !or4 ("the 2or4"" according to the terms stated hereunder: 61 An& permission granted to the Photographer shall e7tend to his/her successors5 legal representati3es5 licensees and assigns and shall be irre3ocable and perpetual !ithout an& further or additional claim for compensation b& either the odel or the Parent/Guardian1 *1 Permission is specificall& granted for the 2or4 to be edited5 altered5 distorted5 used in !hole or in part5 in con8unction !ith other images5 graphics5 te7t and sound in an& !a& !hatsoe3er and !ithout restrictions b& the Photographer1 -1 Permission herein granted to the Photographer is absolute and final and shall not be sub8ect to further inspection or appro3al b& either the odel or Parent/Guardian at an& stage in the use of the 2or41 (1 9se of the 2or4 shall be unrestricted as to location5 :uantit& or fre:uenc&5 ma& be for an& purpose and in an& medium !hatsoe3er5 !hether foreseen or unforeseen at this time5 e7cept !here such use is in contra3ention of the la!1 ;1 9se of the 2or4 ma& be in con8unction !ith the odel<s o!n or fictitious names1

,1 The Photographer shall o!n all rights in the 2or4 !hich shall accrue to the benefit of his/her successors5 legal representati3es and assigns1

=1 Not!ithstanding the abo3e5 the follo!ing uses are specificall& noted and agreed to5 and specific exclusions for use listed here shall ta4e precedence and restrict the use of the 2or4 accordingl&:

/1 The Parent/Guardian !arrants ha3ing read and understood this odel >elease Agreement and !arrants being the Parent or legall& appointed Guardian of the odel5 and being of legal age and competenc& and !ith e3er& right to enter into an agreement on behalf of the odel1 .1 2ith full 4no!ledge of the abo3e5 the Parent/Guardian acting on behalf of the odel hereb& releases and shall hold harmless the Photographer and his/her successors5 legal representati3es5 licensees and assigns from all claims or damages including but not limited to defamation or 3iolation of right of pri3ac& or publicit&5 resulting from or associated !ith the use of the 2or41 6)1 The Parent/Guardian agrees that the pro3isions contained herein shall be binding upon the Parent/Guardian and odel as !ell as their collecti3e successors5 legal representati3es and assigns1 661 ?n addition to this agreement5 ?5 agree not to hold the photographer and/or its compan& responsible for an& damages5 accidents5 in8uries and/or an& form of mishap that could ta4e due to but not limited to m& o!n negligence1 ? enter the abo3e propert& at m& o!n ris4 and accept responsibilit& for m&self and/or m& minor1 6*1 This Agreement shall be construed5 interpreted and go3erned in accordance !ith the la!s of the %tate of Nebras4a and should an& pro3ision of this Agreement be 8udged b& an appropriate court as in3alid5 it shall not affect an& of the remaining pro3isions !hatsoe3er1 6-1 The parties agree that an& or all parts of this agreement ma& be submitted to the other part& in legible and recordable electronic form and upon ac4no!ledgement of receipt b& the recei3ing part& shall become 3alid parts of the agreement1 %igned at __________________ on this _____da& of ___________________*)____ Parent<s/Guardian<s %ignature: _______________________________ %igned at __________________ on this _____da& of ___________________*)____

Photographer's Signature: _______________________________