Model / media release

1

Who this covers

I confirm that I am the person shown in the media, or I am the parent or legal guardian of a minor shown in the media and I have authority to agree for that minor. I am legally able to enter this agreement. I had a chance to ask questions before signing.

2

Session details (form fields)

Client full legal name; Photographer / business name; Session date; Session type; Email and phone; Signature and date.

3

What I allow (choose each type separately)

I grant permission to create and use the media types I select on this form. Only the types I select are covered. Types I do not select are not included.

4

Where the media may be used (and opt-out)

For each use location I select, Copper Nickel Memories may use the permitted media for that purpose. I may leave a use location unchecked, or mark it as opted out on this form. Unchecked or opted-out uses are not allowed under this release.

5

No extra pay

I will not receive additional compensation for the uses I permit above, beyond any fees already agreed for the session or services.

6

Withdrawing permission

I may withdraw permission for future uses by contacting Copper Nickel Memories in writing (email is fine) using the contact info on this form or the business website. Withdrawal does not require already printed, posted, or published uses to be pulled back in every case — for example, materials already printed, ads already run, or posts already published may remain. New uses after a valid withdrawal will stop for the locations and media types I withdraw.

inquiries@coppernickel.com · (801) 697-3672

7

Acknowledgment

I have read this release, understand it, and agree to it of my own free will. If I am signing for a minor, I am that minor’s parent or legal guardian.