Model Release

Your Information

Child's Information

Release Terms

Effective as the date shown below, approved for the past use in permission for present and future use is being granted to, Clique photography, Lowell Bashore Jr.( the photographed party), as more fully explained in this consent and release. The photograph's party is an adult and it's fully authorized to sign this consent release. If photograph party is a minor a parent or a guardian signature is required. The photograph party also consents to the use of my own name or any fictitious name which is been chosen in connection with the aforesaid photographs.


For value received, receipt of which is hereby acknowledged the photographed party hereby grants consent to space, its agents, employees, licensees, and successors in interest parentheses collectively, the released party parentheses and authorized the use of any or all photographs taken of me, and my reproduction of them in any form in any media whatsoever in any derivative work based thereon throughout the world, and to use them to publicize, promote and advertise, including but not limited to the use for point of sale advertising.

The photograph party also consents to the use of my own name or my fictitious name which may be chosen in connection with the aforesaid photographs.

The photographed party hereby waive any rights that I may have two inspect and/or approve the book or the advertising copy that may be used in connection there with or the use to which it may be applied.

The Parent or Guardian or the photograph party warrants that she or he is the undersigned and that she or he has read this consent and released prior to the signing of this document, that the undersigned understands it, and that the undersigned freely enters into this consent and release.

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