Free model release form 09
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Stephen Potts Photography
Photographer Information

Name: Stephen Potts
Address: 5 Whitecherry Hill
Town/City: Killinchy

County: Down

Country: Northern Ireland

Post Code: BT23 6QU

Phone: 07836 613372

Email: [email protected]

Signature: ______________________________Date: _______________
(by signing this I confirm I took the photographs)
For good and valuable consideration, the receipt of which is hereby acknowledged, I irrevocably consent to and
authorise the use and reproduction by you the photographer, or anyone authorized by you, of any and all
photographs taken of me today. I hereby agree to allow photographs of me to be offered for sale without further
consideration to me. I hereby give the unrestricted right and permission to copyright and use, re-use, publish,
and republish photographs or pictures of me or in which I may be included without restriction as to changes or
reproduction hereof in colour or otherwise, made through any and all media no