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.

• _____ I am fully aware that modeling for Life Drawing / Figure Drawing implies nudity

• _____ I am fully aware of the risks implied when modeling nude in class or online, and acknowledge that modeling is my choice and my sole responsibility

• _____ I am fully aware that the instructor or Shawnee State University cannot be held responsible _____ for any incidents such as breach of privacy/confidentiality, unauthorized or accidental diffusion of content, or any other type of online diffusion

• _____ I am of adult age, legally allowed to model, and signing this Release with full consent

Model Name (Print):

SSU I.D. (if applicable):

Address:

Phone Number:

Email:

Model Signature:

Witness: