Model's Name ______________________________

I hereby grant Steve/Stephen McKinnis and his client, ________________________ permission to use my likeness in a photograph in any and all of its publications, including web sites or any electronic medium for promotional purposes, samples of work or any promotional materials be it in print or electronic, without payment or any other consideration.

I understand and agree that these materials will become the property of Steve/Stephen McKinnis and his client listed above and will not be returned.

I hereby irrevocably authorize Steve/Stephen McKinnis and his client to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing either Steve McKinnis or his client (listed above) for any

other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph.

I hereby hold harmless and release and forever discharge the Department of Labor from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I am 21 years of age and am competent to contract in my own name. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.

_____________________________________________ ________________________ (Date)

(Signature)

______________________________________________________ _____________________________ (Date)

(Printed Name)

If the person signing is under age 21, there must be consent by a parent or guardian, as follows:

I hereby certify that I am the parent or guardian of _________________________, named above, and do hereby give my consent without reservation to the foregoing on behalf of this person.

___________________________________________ ________________________ (Date)

(Parent/Guardian’s Signature)

____________________________________________________________________________________
(Parent/Guardian’s Printed Name)

The undersigned agrees to the terms of this agreement on behalf of his or her organization or business.

On behalf of the client (authorized signature):

_______________________________________ Date ________________

On behalf of Steve McKinnis (authorized signature)

_______________________________________ Date ________________

Last updated February 18, 2010


Steve McKinnis: Web/Graphic Designer [PC & MAC]
Mail: 1010 University Avenue #754 | San Diego, California 92103
619.913.3101 & 619.543.9795
E-mail me directly at: steve@stevemckinnis.com