People's Colloquium—Model Release Form

I,_______________________________________(Name of Model or Parent or Legal Guardian of Model), hereby give _________________________________(Name of Artist) and those acting on his or her legal behalf the permission to distribute, sell, publish, republish, copyright, and otherwise use the artwork(s) created on (Date) that features my likeness.

The artwork(s) that features my likeness may be named by the artist however they choose. I am aware that the themes present in the artwork(s) that features my likeness will be determined solely by the artist. The resulting artwork(s) may be used in promotions, advertisements, publications,or in any way the artist chooses, in print, on the web, or in any other public or private medium. I will receive no monetary compensation from the sale or publication of the artwork(s), either from the original, prints, or any other form.

I have read and completely understood all terms set out in this Model Release Form contract. I am of legal adult age. By signing this Model Release Form contract, I am releasing all rights and claims to the artwork to the artist, and am agreeing to all preceding terms.

Date:_________________________________________________________________

Full Name (Please Print):____________________________________________________

Signature:______________________________________________________________

Address:_______________________________________________________________

City:__________________________________________________________________

State (Include Zip Code):____________________________________________________

Phone Number:_______________________________________________________________

Witness:_______________________________________________________________