Release Form

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INSIDE OUT Haverhill PROJECT

Model Release Form

I,________________________________________________ (insert full name of subject OR name of parent or guardian if subject is under 18 years of age) hereby authorize the artist JR and the organizers of the INSIDEOUT project to use the photos and/or video footage in which I (or the child/minor of whom I am legally responsible for) appear in part or entirety, alone or with other subjects, for any purpose and any media (book, press, video, film, internet, artwork, etc.), as part of INSIDEOUT Project. I confirm that I understand the nature of the project and hereby assign all of my rights to use any photographic portraits of myself (or the minor I represent) to the organizers of INSIDEOUT Project, JR, and TED Conferences.

This assignment is made free of charge, for the world and for the duration of my intellectual property rights.

Date: ………………..

City of Residence: ………………..

Signature of Subject (or parent/guardian, if subject is under 18 years of age):

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If subject is a minor (under 18 years of age), please write their full name

here_______________________________________________

email:_______________________________________________

Tell us about your gift, talent, creative way, skill. We want to know what makes you special. You are important to our community!

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