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Deon van der Merwe Photography @ 1 Peregrine Place, Peregrine street, Amberfield Glen, Centurion, South Africa
All Copyrights Reserved by Photography Company 2011
Deon van der Merwe Photography
Contact Deon Cell: 082 571 0277
Iloreez Cell: 072 207 8872
Visit our New Website : http://www.deonvandermerwe.co.za
Or Email us at [email protected]
Model Release Form For Minors
For good and valuable consideration, the receipt and legal sufficiency of which is hereby acknowledged,
I
_________________________
(“Model”) hereby grant to Deon van der Merwe
and DeonvanderMerwe Photography (collectively, the "Photographer"), the Photographer’s assigns, and those
persons acting with the Photographer’s authority and permission, the right to take and create photographs (in all
formats) and other graphical depictions incorporating my likeness, in any and all media, whether now known or
hereafter created (the “Photographs”).
I hereby agree that all rights in and to the Photographs, including the copyright, are and shall remain the sole
property of the Photographer, free and clear from any claims by me or anyone acting on my behalf.
The Photographer’s rights include, but are not limited to, the rights, in perpetuity, to:
Use, re-use, publish, and re-publish the Photographs;
Alter, modify or otherwise change the Photographs, in any manner the Photographer desires;
Combine the Photographs with textual matter and/or with other pictures and/or media; and,
Use the Photographs for illustration, promotion, art, editorial, advertising, trade, publishing, or any other
purpose whatsoever.
I hereby release, discharge, and agree to hold harmless the Photographer, the Photographer’s heirs, legal
representatives and assigns, and all persons acting under the Photographer’s authority or those for whom he/she is
acting, from any liability by virtue of any use of the photographs or any changes or alterations made thereto.
I warrant and represent that I am the father/mother/guardian of _______________________, the Model above
named. I have read the above authorization, release, and agreement, and I am fully familiar with the contents
thereof. This release shall be binding upon me and my heirs, legal representatives, and assigns.
Photographer:
Name Print:
Deon van der Merw
e
Address:
1 Peregrine Place, Peregrine Street, Amberfield
Glen Estate, Rooihuiskraal North, 0157
Centurion, Gauteng, South Africa
Date: .......................
Signature:..........................
Parent/Guardian:
Witness:
Model Name:
Name Print: .......................................................
Parent Name:
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Date: ....................... Signature:..........................
Email address:
..........................................
Phone Number:
..........................
Address:
...............
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Date: .......................
Parent Signature:..........................