Model Release Form




I                                                               , for good and valuable consideration, the receipt of which is acknowledged, give to George M. Lewis unrestricted permission to copyright and/or use, and/or publish photographic portraits or pictures of me, the prints, and digital information pertaining to them, in still, single, multiple, digital, moving or video format, or in which I may be included in whole or part, or composite, or reproductions thereof, in color or otherwise, made through any media in his studio or elsewhere for art, or any lawful purpose. 

I acknowledge that some of these photographic portraits or pictures of me, digital or print, may be published unless it can be shown that the said photograph was maliciously caused, produced, and published for the sole purpose of subjecting me to conspicuous ridicule, scandal, reproach, scorn, and indignity. 

Photographer understands and acknowledges that model must be contacted via written correspondence if pictures are to be used for anything other than promotional use. 

Model understands that because this is a Time for CD (TFCD)/Test shoot she/he is getting digital images in lieu of monetary compensation.  Model will not sell pictures/digital images, and only use them for promotional use such as website, portfolio, zed/comp card, etc. 

I further acknowledge that the photography session was conducted in a completely proper and highly professional manner, and this release was willingly signed at its termination. 

The above mentioned only pertains to the photography session described below.


Date of Photo Session:  ________________


Photo Session Description:     ____________________________________________________________________


Modelís First Name:  __________________________  MI:  _____ Last Name:   __________________________________


Address:  __________________________________


City:  __________________________________    State: ________  Zip: ___________________


Phone Number:   __________________________________              Date of Birth:  _____________________


Email Address:    __________________________________


Please check one:

______ I represent that I am over the age of eighteen years and that I have read the foregoing and fully and completely understand the contents hereof. 

______ I represent that the model is a minor and that I am the parent or duly authorized representative of the model and that I have read the foregoing and fully and completely understand the contents hereof. 


Photographer:  George M. Lewis 


_________________________________      __________________________________

(Model's or Parent's Signature)                          (Print Model's or Parent's Names)



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Last modified: 03/27/08