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Authorization To Photograph
(Release By Subject)
1. Release made by [name and address of party to be
photographed] in favor of [name and address of photographer] this
2. Consideration. This Release is being executed by Releasor
for the sum of ---------- dollars ($----------) paid by Releasee to
Releasor, receipt of which is acknowledged.
3. Subject Matter of Release. The photographer is granted by
this Release the right to photograph Releasor, as well as to display,
exhibit, [other means, e.g., video rights] those photographs.
4. Release Binding. [Name] (Releasor) releases [name]
(Releasee) from any future claims for libel, slander, or any other claim
by Releasor against Releasee or Releasee's successors or assigns.
IN WITNESS WHEREOF, Releasor has set Releasor's hand this
*** If Required By State Law ***
ACKNOWLEDGEMENT BY NOTARY PUBLIC
State of ________)
On ________, before me, ________, Notary Public, personally appeared ________, [Name(s)] who proved to me on the basis of satisfactory evidence to be the person(s) whose names(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies) and that by his/her/their signatures on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under the PENALTY OF PERJURY under the laws of the State of _________ that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Name of Notary
My Commission Expires