Model consent & release form

First name

Last name

Date of birth

I hereby grant the irrevocable, perpetual and unrestricted right and permission to Clarissa Sofía; to take, use, re-use, print, publish, and republish photographic portraits or pictures of me or in which I may be included, in whole or in part, or composite or distorted in character or form, without restriction as to changes or a as to changes or alterations, in conjunction with my own or a fictitious name, or reproductions thereof in color or otherwise, made through any medium and location by Clarissa Sofía, and in any and all media now or hereafter known, specifically including but not limited to print media and distribution over the internet for illustration, promotion, art, editorial, advertising, trade, or any other purpose whatsoever.

I hereby warrant that I am of full age and have the right to contract in my own name. I have read the above authorisation, release, and agreement, prior to its execution, and I am fully familiar with the contents of this statement. This agreement shall be binding upon me and my heirs, legal representatives, and assigns.

Todays Date

Signature