Permission for Photography    

(Toestemmingsverklaring van fotomodellen)

​

*copy the following text, fill out, sign and mail to foto-rik@live.nl

​

MODEL RELEASE AND CONSENT AGREEMENT

1.

For valuable consideration, the adequacy of which

is acknowledged, for your

photographing me, and knowing that you have and wil

l expend substantial expenses and time

in reliance upon this Release and Consent, I

irrevocably and absolutely consent to the

unrestricted use by __Rik Besselink photography__

and his heirs, successors, assigns, and

designees (“Photographer”), and those acting with 

Photographer’s permission and authority, of

my name and any and all photographic or other images

(“Images”) of me that Photographer

creates or makes, for all purposes, in any form, in

conjunction with my own or a fictitious name,

and in any and all media, including, without

limitation, advertising, art, promotion, solicitation,

or trade.

2.

I waive any right to inspect or approve the finished

Images, advertising copy, text, or

other printed matter that may be used in

conjunction therewith, or to the eventual use that the

Images may be applied.

3.

I release and discharge Photographer and those

acting under Photographer’s authority

from any and all liabilities, claims and demands

arising out of or relating to any blurring,

distortion, use in composite form, or alteration

whether intentional or otherwise, that may

occur or be produced in connection with the Images,

or in connection with any processing,

alteration, transmission, display, publication or o

ther use of the Images.

4.

I hereby forever release and discharge Photographer,

his heirs, legal representatives,

agents, assigns and the party for whom the photographs

were made, from any and all claims,

actions and demands arising out of or in connection

with the use of said Images, including

without limitation, any and all claims for invasion

of privacy and libel.

5.

This Agreement constitutes the sole, complete and

exclusive agreement between

Photographer and me regarding the Images and I am

not relying on any other representation

whether oral or written.

6.

I hereby affirm that I am over the age of majority

and have the right to contract in my

own name. I have read the above authorization,

release and agreement, prior to its execution;

I fully understand the contents thereof. This

agreement shall be binding upon me and my heirs,

legal representatives and assigns.

​

​

SIGNATURE/DATE_______________

​

TELEPHONE #__________________

​

NAME_________________________

​

ADDRESS______________________

​

IF MODEL IS A MINOR, PARENT OR GUARDIAN MUST SIGN B

ELOW

:

I, the undersigned, being parent or guardian of the

minor whose name appears above, hereby

consent to the foregoing conditions and warrant tha

t I have the authority to give such consent.

​

SIGNATURE/DATE    _______________

​

TELEPHONE #    __________________

​

NAME OF PARENT/GUARDIAN______________

​

ADDRESS    ______________________

​

​

​

​