For valuable consideration which I have received, I grant William Long/Longshots
Photography and his agents and assigns, the irrevocable and unrestricted right
and permission to use or alter any photographic images of me, or in which I
may be included in any media now or hereafter known for any other purpose whatsoever.
I hereby release the Photographer and his agents and assigns from all claims
and liability relating to the use of the said photographs.
| NAME (print) | _______________________________ | ||
| DATE | _______________________________ | ||
| SIGNATURE | _______________________________ | ||
| PHONE | _______________________________ | ||
| ADDRESS | _______________________________ | ||
| CITY | _______________________________ | STATE | __________ |
| IF MINOR, SIGNATURE OF PARENT/GUARDIAN | |||
| _______________________________ | |||
| WITNESS | _______________________________ | ||