Skip to main content

To grant permission to Goldbelt, Inc., subsidiaries, affiliated organizations, and persons use of photographed or video images.

In consideration of my engagement as a model, and for other good and valuable consideration herein acknowledged as received, I hereby grant to Goldbelt, Incorporated, subsidiaries and agents, his/her heirs, legal representatives and assigns, those for whom Photographer is acting, and those acting with his/her authority, and permission, the irrevocable and unrestricted right and permission to copyright, in his/her own name or otherwise, and use, re-use, publish, and re-publish photographic portraits or pictures of me or in which I may be included, in whole or in part, or composite or distorted in character or form, without restriction as to changes or alterations, in conjunction with my own or a fictitious name, or reproductions thereof in color or otherwise, made through any medium at his/her studios or elsewhere, and in any and all media now or hereafter known for illustration, promotion, art, editorial, advertising, trade, or any other purpose whatsoever. I also consent to the use of any printed matter in conjunction therewith.
Please type your name in the box below to serve as your e-signature.
Please type your name in the box below to serve as your e-signature.
Please enter your email below if you would like a copy of this photo release form.