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Virginia Model Release Form 3

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This form is provided by the City of Hampton, Virginia to grant the permission of the use and publication of the releasor's photographic pictures or portraits.

Virginia Model Release Form 3
Virginia Model Release Form 3
MODEL RELEASE
I hereby give the City of Hampton, Virginia, a Virginia municipal corporation acting through authorized agents, officers or employees, the right and
permission to take, copyright and/or use, publish, reuse and republish photographic pictures or portraits made of me, with the understanding that my
image may be distorted in character or form, representing my own name or a fictitious name, through whatever media the City chooses in keeping
with its purposes.
I hereby release, discharge and agree to save harmless from claims or liability arising from the City’s use of images of me, the City of Hampton, its
agents, officers, employees and other persons or entities acting under the permission or request of the City in publishing or distributing the finished
product, even though the finished product may be distorted, blurred, altered, or used in composite form, either intentionally or otherwise for the
City’s lawful purposes.
I hereby waive any right to approve the finished photograph or any copy which might be used in conjunction with the finished photograph.
I hereby warrant that I am at least eighteen years of age and am competent to contract in my own name insofar as this agreement is concerned (or, if
under eighteen years of age, my parent/guardian has completed the certification set forth below).
I understand and agree that my sole compensation shall be as follows: ___________$0.00________________________________________________
I have read the foregoing release, authorizations and agreement, before affixing my signature below, and warrant that I fully understand the contents
thereof.
Signature: ____________________________________________ Address: __________________________________________
Date: __________________
Witness: _____________________________________________ Address: __________________________________________
I hereby certify that I am the parent/guardian of: ____________________________________________________ a minor under the age of eighteen
years. In consideration of value received, the receipt of which is hereby acknowledged, I hereby consent that any photographs which have been or
are about to be taken by the photographer may be used by him/her for any lawful purposes set forth in the release above, signed by the minor model,
with the same force and effect as if signed by me.
Parent or Guardian: _______________________________________________________
Address: _______________________________________________________________
Virginia Model Release Form 3