MODEL RELEASE FORM                Return to Information Pages

I (the model) explicitly grant to the photographer (the photographer)

and to his/her assignees and licensees the absolute right and

permission to use, publish or sell the photograph(s) referred to

below, in which I am included, in any medium, throughout the world,

without any restriction whatsoever as to the nature of the use or

publication or as to the copy of any printed matter accompanying

the photograph(s). I understand that the images

may be altered and I waive the right to approve of any finished product.

I understand that I do not own the copyright of the photograph(s) and that

they may not be used in a defamatory way, as set out by law.

I certify that I am over 18 years of age and that I have the full legal

right to execute this agreement.

Name of Photographer:    Stephen Hepworth

Desription & Date of Photography: _____________________________________________


Signature of Model: _____________________________       DATE: _____/_____/ 200____

Name of Model: __________________________________    Age of Model: ____________

Model Agency _________________________________

(if under 18 years of age:)    Name of Parent/Guardian ________________________________

Signature of Parent/Guardian ____________________________________________________

Address of model: _________________________________________________________

__________________________________________________  Post Code _______________

Telephone: _____________________     Email address: ___________________@ ______

Witness: ______________________________________


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Last updated: 03/28/05.