Model Release – Kootenay Meditation
In exchange for consideration received ($1.00 or 1 hour Datse Multimedia Time), I grant Datse Multimedia Productions, and Kootenay Meditation, permission to use my name and photographic likeness for the below stated purposes (select all that apply):
- __ Website use (any)
- __ Website use (kootenaymeditation.com)
- __ Use in multimedia (any)
- __ Use in multimedia (kootenaymeditation.com)
- __ All other usage (any)
- __ All other usage (kootenaymeditation.com)
- __ Photographic Print use
- __ Portfolio use (Datse Multimedia)
- __ Sale of image
- __ Modification of image
- __ Marketing
- __ Educational use
- __ Any legal usage (implies all of the above)
The name I would like to be referred to as on the site is (may be anonymous, made up name, etcetera. Some names may not be accepted for a variety of reasons, in such cases anonymous will be used, if left blank legal name will be used):
Preferred Name: __________________
If you would like your photographs to be released with a intellectual property license other than the site license (Creative Commons Attribution-Noncommercial-Share Alike 2.5 Canada http://creativecommons.org/licenses/by-nc-sa/2.5/ca/) please check here ____ and attach information regarding the license that you wish to use (may be more or less restrictive, the option is yours).
Print legal name: _______________
Signature: __________
Date: _______
If model is under 19:
I, ___________, am the parent/legal gaurdian of the individual named above; I have read this release and approve of its terms
Print legal name: _______________
Signature: __________
Date: _______
