Photo Model Release Form Required for all photos with recognizable people. Date* Model/Person's Name* Referred to as "Model" within the agreement.Location and/or Event of Shoot* Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code This Photograph Release is between Topeka & Shawnee County Public Library, a municipal corporation with its principal place of business at 1515 SW Tenth Avenue, Topeka, Kansas, herein after referred to as “TSCPL;” and the above named person, an individual residing at the address listed above, hereinafter referred to as “Model.” In consideration of the terms of this Release, I hereby give TSCPL and those acting with TSCPL’s authority and permission: (a) the unrestricted right and permission to copyright and use, re-use, publish, and re-publish photographic pictures and/or video of me or in which I many be included intact or in part, composite or distorted in character or form, without restriction as to changes or transformations in conjunction with my own or a fictitious name, or reproduction hereof in color or otherwise, made through any and all media now or hereafter known, for illustration, art , promotion, advertising, trade, or any other TSCPL purpose; (b) the permission to use the pictures in any printed material including posting the photographs and/or video on Topeka and Shawnee County Public Library’s web site, YouTube, Facebook, blip.tv and like sites; and (c) a waiver of any right that I may have to examine or approve the completed product or products or the copy of printed material that may be used in conjunction therewith or the use to which it may be applied. I hereby release, discharge and agree to hold harmless TSCPL and all persons functioning under TSCPL’s authority and permission from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form whether intentional or otherwise, that may occur or be produced in the taking of said picture(s)/video or in any subsequent processing thereof, as well as any publication thereof, including without limitation any claims for libel or invasion of privacy.This release shall be binding upon Model and Model’s heirs, legal representatives, and assigns. I hereby affirm that:* I am over the age of majority and have the right to agree to the terms of this Photograph Release in my own name; and that I have read, fully understand and agree to the terms of this Photograph Release prior to its execution. I am of the age of majority; that I am authorized to contract for the Model; and that I have read, fully understand and agree to the terms of this Photograph Release prior to its execution. Model SignatureParent/Guardian SignatureImage of ModelAccepted file types: jpg, png, Max. file size: 2 GB.