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CS
PRODUCTION AND DESIGNZ
MODEL / PERFORMER ID. & RELEASE FORM
TO
BE FILLED OUT BY PRODUCER
DATE OF SHOOT:___________________________________________________________
SHOOT LOCATION: _________________________________________________________
PHOTOGRAPHER(S): ________________________________________________________
NAME
OF COMPANY (S) REPRESENTED BY PRODUCER/PHOTOGRAPHER
_________________________________________________________________________
PERFORMER(S)
TRUE NAME:______________________________________________________
STAGE
NAME IF USED:_____________________________________________
RESIDENCE
ADDRESS:____________________________________________
CITY:______________________STATE: ______________ZIP:_______________
PERFORMER CONTACT INFORMATION:
TELEPHONE (H)_____________________________________
CELL #_____________________________________________
PAGER / V.M.______________________________________
PERORMERS:
DATE OF BIRTH: ___________/________/__________
SOC SECURITY: ___________/________/__________
ID’S PRESENTED FOR VERIFICATION
D.L._________________STATE ISSUED______ SOC CARD________ (ID’S PROVIDED/CHECKED
Y / N)
ID’S OTHER______________________________________________ (COPIES
OF ID’S: DIGITAL / PAPER COPY)
PERFORMERS
STATEMENT: UNDER PENALTY OF PERJURY, I SWEAR THAT THE FORGOING IS
TRUE AND CORRECT AND THAT EACH OF THE IDENTIFICATION
DOCUMENTS WHICH I HAVE SIGNED AND ATTACHED HERETO IS VALID, HAS NOT BEEN
ALTERED OR FORGED AND CONTAINS TRUE INFORMATION HEREIN.
EXECUTED THIS DAY____________OF_____________200____
PERFORMERS SIGNATURE:_____________________________________
AFFIDAVIT
OF PRODUCER: UNDER PENALTY OF PERJURY, I SWEAR THAT THE FORGOING IS
TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEVE, AND THAT I HAVE
PERSONALLY OBSERVED THE ORIGINALS OF EACH IDENTIFICATION DOCUMENT WHICH
HAVE BEEN SIGNED BY THE PERFORMER IDENTIFIED HEREIN AND ATTACHED TO THIS
RELEASE AND IDENTIFICATION FORM.
EXECUTED THIS DAY: ____________ OF _____________ 200_____
PRODUCER SIGNATURE:_____________________________________
MODEL
RELEASE AND LIABILITY FORM
IN
CONSIDERATION OF MY ENGAGEMENT AS A MODEL, AND FOR OTHER GOOD AND VALUABLE
CONSIDERATIONS HEREIN ACKNOWLEDGED AS RECEIVED. I IRREVOCABLY GRANT CS
PRODUCTION AND DESIGNZ (HEREIN THE PHOTOGRAPHER) AND ASSOCIATES (ANY SUCH
PERSON ACTING ON THE BEHALF OR WITH THE PHOTOGRAPHERS PERMISSION) THE
UNRESTRICTED RIGHTS AND PERMISSION NOW AND HEREAFTER TO COPYRIGHT AND
TO USE, DISPLAY, SELL, PUBLISH, AND REUSE AND REPUBLISH ANY AND ALL IMAGES
(INCLUDING BUT NOT LIMITED TO ANY AND ALL VISUAL, AUDIO, AND OTHER IMAGES
OR IMPRESSIONS, PHOTOGRAPHS, NEGATIVES, SLIDES, VIDEO AND AUDIO RECORDINGS,
MOVING PICTURES, DIGITAL IMAGES AND ANY OTHER ORIGINAL OR DERIVED WORKS)
OF MYSELF. I GRANT THIS PERMISSION IN PERPETUITY IN MY OWN BEHALF AND
ON THE BEHALF OF MY ESTATE IN THE EVENT OF MY DEATH. THIS DOCUMENT COVERS
ALL USES AND PURPOSES (ALL USES IN ALL CURRENT AND ANY FUTURE MEDIA THE
PHOTOGRAPHER AND ASSOCIATES CHOSE, INCLUDING BUT NOT LIMITED TO ILLUSTRATION,
ADVERTISING, ART, PUBLICATIONS, TRADE, COLLECTIONS, REPRODUCTIONS, PROMOTIONS,
EDITORIAL, BROADCAST, PRODUCTS AND SALES).
I HEREBY RELEASE, DISCHARGE AND AGREE TO HOLD HARMLESS THE PHOTOGRAPHER
AND ASSOCIATES FOR ANY AND ALL USES OF MY LIKENESS INCLUDING BUT LIMITED
TO MY OWN FICTIONAL NAME, IDENTITY, FORM OR SHAPE, OR ANY OTHER CHANGES
OR DISTORTIONS IN CHARACTER OR FORM WHETHER INTENTIONALLY OR OTHERWISE,
INCLUDING BUT NOT LIMITED TO BLURRING, DISTORTION, ALTERATIONS, OPTICAL
ILLUSIONS, OR USE IN COMPOSITE FORM, OR THROUGH THE USE OF ANY ACCOMPANYING
MATERIALS OR TEXT).
I FURTHER CONSENT TO THE USE OF ANY PRINTED MATTER OR TEXT ( WHETHER SUCH
IS FACTUAL, FICTIONAL, OR OTHERWISE IN CONJUNCTION WITH AND AND ALL USES
OF MY LIKENESS OR IMAGES. I WAIVE ANY AND ALL RIGHTS TO INSPECT OR APPROVE,
TO VIEW ORIGINAL MATERIALS, DESIGNS, WORKS, FINISHED PRODUCTS, OR ASSOCIATED
PRINTED MATTER.
WITHOUT LIMITATIONS,
I HEREBY
RELEASE, DISCHARGE, AND AGREE TO SAVE HARMLESS THE PHOTOGRAPHER AND ASSOCIATES
FROM ANY CLAIMS OF LIBEL, INVASION OF PRIVACY, OR DEFAMATION OF CHARACTER.
THIS DOCUMENT REMAINS VALID EVEN IF SUCH USE (S)
SUBJECT ME TO SCANDAL, RIDICULE, REPROACH, SCORN, OR INDIGNITY. IN THE
EVENT THAT ANY ACTION IS BROUGHT BY ME OR ANY THIRD PARTIES CONCERNING
THE USE OF MY LIKENESS OR IMAGES, I AGREE TO PAY THE COSTS AND EXPENSES
OF THE PHOTOGRAPHER AND ASSOCIATES FOR ANY LEGAL ACTION, INCLUDING ATTORNEY
FEES WHETHER OR NOT SUCH ACTION PROCEEDS TO JUDGMENT.
I ACKNOWLEDGE THAT ALL IMAGES ARE COPYRIGHTED PROPERTIES OF BOTH PHOTOGRAPHER
AND ASSOCIATES AND SAID PERSONS MAY LICENSE, SELL, OR OTHERWISE DISPOSE
OF ANY WORK, IMAGE(S) OR ALL MATERIALS AT ANY TIME.
I ALSO UNDERSTAND THAT ANY PHOTOGRAPHS, VIDEO, ARTWORK, OR OTHER MATERIALS
I RECEIVE FROM THE PHOTOGRAPHER ARE COPYRIGHTED AND INTENDED FOR PERSONAL
USE ONLY. THE PHOTOGRAPHER WILL GRANT ME RIGHTS TO REPRODUCE AND TO USE
ALL SUCH PHOTOGRAPHS, VIDEO, ART WHICH I RECEIVE FOR MODELING PROMOTIONAL
PURPOSES, WITH THE RESTRICTION THAT NO CHARGE OF ANY KIND IS EVER MADE
TO THOSE RECEIVING SUCH PHOTOS OR REPRODUCTIONS UNLESS PREVIOUSLY NOTED
AND AGREED UPON BY PRODUCER AND PERFORMER PRIOR TO MODELING ENGAGEMENTS.
ALL USES OF SAID IMAGES MUST HAVE AN A PHOTO CREDIT AT LEAST 6 POINT FONT
SIZE OR GREATER, DIRECTLY ADJACENT TO THE PHOTO(S) STATING THAT CS PRODUCTION
AND DESIGNZ AND THAT ALL WORK REPRODUCED IN VOLUMES GREATER THAN 10 WILL
REQUIRE THAT THE MODEL PROVIDE THE PHOTOGRAPHER WITH AT LEAST 2 FINISHED
COPIES FOR COPYRIGHT VERIFICATION AND STUDIO PORTFOLIO USES.
I HEREBY TESTIFY THAT I ENTER INTO THIS CONTRACT FREELY, WITHOUT ANY UNDUE
INFLUENCE OR PRESSURE. I AGREE TO ACCEPT FULL RESPONSIBILITIES FOR ALL
MY ACTIONS (INCLUDE BOTH BUT NOT LIMITED TO ALL MODELING AND POSING, DRIVING
TO AND FROM SITES OF WORK, AND ALL INTERACTIONS WITH OTHERS AND WITH THE
PHOTOGRAPHER) . I AGREE TO BE SOLELY RESPONSIBLE FOR ALL MY ACTIONS EVEN
IN THE CIRCUMSTANCE THAT I CHOOSE TO TAKE ANY SUBSTANCE (INCLUDING BUT
NOT LIMITED TO ALCOHOL, PRESCRIPTION OR ANY OTHER DRUGS, PLANTS, OR CHEMICALS,
WHETHER LEGAL OR OTHERWISE WHICH MAY AFFECT MY THINKING AND JUDGMENT.
I HEREBY TESTIFY THAT I WILL VERBALLY AND PHYSICALLY REFUSE ANY POSING
OR OTHER ACTIVITIES WHICH I AM NOT FULLY COMFORTABLE AND WANTING TO PERFORM.
I UNDERSTAND
THIS MODEL RELEASE IS NOT AN EMPLOYMENT CONTRACT, AND THEREFORE THERE
IS NO OBLIGATION FOR ME TO CONTINUE POSING FOR THE PHOTOGRAPHER OR FOR
THE PHOTOGRAPHER TO CONTINUE WORKING WITH MYSELF. FURTHER, SINCE I WILL
BE CONSIDERED AN INDEPENDENT CONTRACTOR, I AM RESPONSIBLE FOR REPORTING
AND PAYING TAXES ON ANY COMPENSATION RELATED TO MODELING. THIS CONTRACT
CONSTITUTES THE ENTIRE AGREEMENT AND CANNOT BE ALTERED OR VARIED UNLESS
AMENDED IN WRITING AT THE TIME OF THIS SIGNING. NO OTHER PROMISES, REPRESENTATIONS,
RESTRICTIONS, OR AGREEMENTS WILL BE RECOGNIZED.
I AGREE
ALL CLAUSES OF THIS CONTRACT AND IT’S AMENDMENTS ARE SERVABLE, AND
THEREFORE, IF ANY PROVISION OF THIS DOCUMENT IS INVALID OR INOPERATIVE
UNDER LAW, THE REMAINING PROVISIONS SHALL CONTINUE IN FULL FORCE AND EFFECT.
THE LAWS OF THE STATE OF _______________ SHALL GOVERN THIS AGREEMENT.
ALL RIGHTS AND RELEASES ENJOYED BY THE PHOTOGRAPHER SHALL EXTEND TO HIS
/HER ESTATE AND ASSOCIATES IN PERPETUITY. I AGREE AND I UNDERSTAND THAT
I AM NOT DUE AND WILL NOT RECEIVE ANY FURTHER COMPENSATION OR RECOGNITION
FOR USE OF MY IMAGES AND LIKENESS.
I HEREBY STATE UNDER PENALTY OF PERJURY, THAT I AM _____YEARS OF AGE,
AND THAT I AM OF FULL LEGAL AGE AND HAVE THE RIGHT AND ABILITY TO CONTRACT
IN MY OWN NAME. I HAVE READ THE ABOVE AUTHORIZATION, RELEASE, AND AGREEMENT
PRIOR TO IT’S EXECUTION, AND AM FULLY FAMILIAR WITH THE CONTENTS
THEREOF. THIS RELEASE SHALL BE BINDING UPON ME AND MY HEIRS, LEGAL REPRESENTATIVES,
AND ASSIGNS.
I HAVE FULLY READ THIS RELEASE AND AGREEMENT BEFORE SIGNING, AND WARRANT
THAT I FULLY UNDERSTAND THE CONTENT AND MEANING THEREOF.
DATED
____________/_________/___________
LEGAL
NAME IN FULL _______________________________________________
PRINTED
LEGAL NAME IN FULL_______________________________________
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