Photography Permission and Consent

Today's Date *

MM

DD

YYYY

Name *

First Name

Last Name

Phone *

(###)

###

####

For valuable consideration received, which may be nothing, I grant to  Adam Martin ("Photographer") and his legal representatives and assigns, the irrevocable and unrestricted right to use and publish photographs of me, or in which I may be included, for editorial, trade, advertising, and any other purpose and in any manner and medium; and to alter and composite the same without restriction and without my inspection or approval. I hereby release Photographer and his legal representatives and assigns from all claims and liability relating to said photographs. *

I agree to the terms listed above.