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Model Release


FOTOGENIE MODEL RELEASE (Adult): For good and valuable consideration, the receipt and legal sufficiency of which is hereby acknowledged, I (“Model”) hereby grant to Photographer and Ubergram, LLC. (collectively, the “Photographer” a.k.a. “Pro Lenser”), the Photographer’s assigns, and those persons acting with the Photographer’s authority and permission, the right to take and create photographs/videos and other still and/or moving images (in all formats) and other graphical depictions incorporating my likeness, in any and all media, whether now known or hereafter created (the “Content”). I hereby agree that all rights in and to the Content, including the copyright, are and shall remain the sole property of Ubergram, LLC and the Photographer, free and clear from any claims by me or anyone acting on my behalf. Ubergram, LLC and the Photographer’s rights include, but are not limited to, the rights, in perpetuity, to: Use, re-use, publish, and re-publish the Content; Alter, modify or otherwise change the Content in any manner the Photographer desires; Combine the Content with textual matter and/or with other pictures and/or media; and, Use the Content for illustration, promotion, art, editorial, advertising, trade, publishing, or any other purpose whatsoever. I hereby release, discharge, and agree to hold harmless Ubergram, LLC and the Photographer, the Photographer’s heirs, legal representatives and assigns, and all persons acting under the Photographer’s authority or those for whom he/she is acting, from any liability by virtue of any use of the Content or any changes or alterations made thereto. I hereby warrant that I am of full legal age and have the right to contract in my own name. I have read the above authorization, release and agreement, prior to its execution, and I am fully familiar with the contents thereof. This release shall be binding upon me and my heirs, legal representatives and assigns. *
Photographer / Pro Lenser Name *
Photographer / Pro Lenser Name
Photographer / Pro Lenser Phone *
Photographer / Pro Lenser Phone
Photographer / Pro Lenser Address *
Photographer / Pro Lenser Address
Date of Photo Shoot *
Date of Photo Shoot
Image Type *
Model Name *
Model Name
Model Address *
Model Address
Model Date of Birth *
Model Date of Birth
Date of Photo Shoot *
Date of Photo Shoot
Model eSignature *
Witness *
Date *