Publish Date: 04-21-2017 (applies to all material and process work after publishing date).
In consideration of my engagement as a model on ____[month, day]____, ____]year]____, I _______________ (hereafter “Model”), and _______________ (hereafter “Parent”) as Model’s parent or legal guardian, do hereby irrevocably authorize Incarna Gaming Network™ (hereafter “Incarna”) Incarna’s legal representatives, assigns, and those acting under Incarna’s permission and on Incarna’s authority, to copyright, publish, and use in all forms and media and manners for advertising, trade, promotion, exhibition, or any other lawful purpose whatsoever, any depictions of Model made by Incarna or Incarna’s representative, in which Model may be included in whole or in part, alone or in conjunction with other persons, or composite or distorted in character, or form, or based on or involving any stunt poses, in conjunction with Model’s own or a fictitious name, or reproductions thereof in color or otherwise, or in derivative works made through any medium, where said depictions may include any or all of still, single, multiple or moving photographic images or pictures, video recordings or audio recordings (collectively hereafter the “Depictions.”)
Model and Parent do hereby waive any right to inspect or approve the finished product or advertising or other copy that may be used in connection therewith or the use to which they may be applied.
Model and Parent hereby release and agree to hold harmless Incarna, its legal representatives, assigns, and all persons acting under its permission or authority, from any liability by virtue of blurring, distortion, alteration, optical illusion, or use in composite form whether intentional or otherwise, that may occur or be produced in the taking of the pictures, or in any processing tending toward the completion of the finished product, unless it can be clearly shown that the publication thereof were maliciously caused, and produced, and published solely for the purpose of subjecting Model to conspicuous ridicule, scandal, reproach, scorn, and indignity.
Model and Parent hereby affirm that all poses, positions and situations enacted in the Depictions covered in this release were entered into without force, coercion, or threat whatsoever, and were posed freely by Model with Model’s and Parent’s full consent and for Model’s own amusement. Model and Parent further agree to hold blameless and free of all accusation of such force or coercion Incarna, his legal representatives, assigns, and those acting under his permission and on his authority.
Parent hereby affirms that he/she is the mother, father, or legal guardian of Model and that Model’s date of birth is _______________ and that Parent’s date of birth is _______________.
Parent hereby affirms that neither Model’s nor Parent’s execution of this instrument causes a breach of any prior agreement or applicable law, including but not limited to a prior agreement with a modeling agency, talent agency, or other Incarna.
We have read the above authorization and release prior to its execution and are fully familiar with and agree to the contents thereof.
Model’s Legal Name: ______________________________ Model’s Name: ______________________________
Model’s Signature: _______________ Date: _______________
Parent’s Name: _____________________________________________
Parent’s Signature: _____________________________________________ Date: _______________
Street:_____________________________________________
City: ___________________________________State: __________________ Zip: __________
Phone: ______________________ Email:__________________________________________