Release Form for Models

Date________________________________

Shawnee State University Department of Fine, Digital and Performing Arts

In consideration of twenty-five dollars ($25) per hour, receipt of which is acknowledged, I, ____________________________________________, do hereby give _________________________, his or her assigns, licenses, and legal representatives the irrevocable right to use my name (or any fictional name), picture, portrait, or photograph in all forms and media in all manners, including composite or distorted representations, for advertising, trade or any lawful purposes, and I waive any right to inspect or approve the finished version(s), including written copy that may be created in connection therewith. I am of full age. I have read this release and am fully familiar with its contents.

Model Name (Print):

SSU I.D. (if applicable):

Address:

Phone Number:

Email:

Model Signature:

Witness: