Waiver Signed for

EXAMPLE OF A MODEL / ACTOR RELEASE

I, , hereby give Acme, Inc., its assigns, licensees and legal representatives the irrevocable right to use my name/ photograph/ image/ audio recording/ video recording/ and likeness (“My Image”) in all forms and manner including but not limited to publication on Internet Web Sites, broadcasts and any other publications as released to or by Acme, Inc., for .

   I Agree

I understand that Acme, Inc. cannot control unauthorized use of My Image by persons not associated with Acme, Inc. once My Image has been published. I hereby forever waive any right to inspect or approve any publication of My Image by Acme, Inc. I have carefully reviewed and understand the above provisions and agree to be bound by them. 

   I Agree

I voluntarily and irrevocably give my consent and agree to this Release and Waiver. 

   I Agree

I am parent or guardian signing for a minor.

Model / Actor's INFORMATION

MINOR
MINOR
MINOR
MINOR
MINOR
MINOR
MINOR
MINOR
MINOR

Use your finger or stylus to
sign your name inside box

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USE YOUR FINGER OR STYLUS
TO INITIAL INSIDE BOX

Clear and try again