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Minor Model Photo and Video Release Form

In consideration of the engagement of my minor child as a model, upon the terms herewith stated, I hereby give to Donald J. Hajicek, his/her heirs, legal representatives and assigns, those for whom Donald J. Hajicek is acting, and those acting with his/her authority and permission:

a) the unrestricted right and permission to copyright and use, re-use, publish, and republish photographs or video of the minor child described herein, to be included intact or in part, composite or distorted in character or form, without restriction as to changes or transformations in conjunction with the minor child's own or a fictitious name, or reproduction hereof in color or otherwise, made through any and all media now or hereafter known for illustration, art, promotion, advertising, trade, or any other purpose whatsoever.

b) I also permit the use of any printed or multimedia material in connection therewith.

c) I hereby relinquish any right that I may have to examine or approve the completed product or products or the advertising copy or printed matter that may be used in conjunction therewith or the use to which it may be applied.

d) I also hereby waive all rights and claims and release the photographer from any claim or cause of action, whether now known or unknown, relating to the sale, display, license, use and exploitation of the photos or video. I hereby covenant and agree that I shall not bring any action or proceeding or maintain a complaint against the photographer in any court of law, state or local, or before any administrative body, related to the use of the photographs or video.

e) I warrant that I am the parent or legal guardian of the minor child and have full right and authority to grant this consent on behalf of such minor.


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Signed by Don Hajicek
Signed On: December 19, 2017

Signature Certificate
Document name: Minor Model Photo and Video Release Form
lock iconUnique Document ID: 21b6661f359c7991022379246bdc56e175a34e2b
Timestamp Audit
December 19, 2017 12:28 pm MDTMinor Model Photo and Video Release Form Uploaded by Don Hajicek - IP