Model Release

PHOTO RELEASE FORM

I___________________________________ (NAME), for good and valuable consideration, the receipt of which is hereby acknowledged, hereby irrevocably authorize Sara Cieslik to use photographs of me and/or my property and authorize him/(her/their and his/her/their assignees), licensees, legal representatives and transferees to use and publish (with or without my name, company name, or with a fictitious name) photographs, pictures, portraits or images herein described in any and all forms and media and in all manners including composite images or distorted representations, and the purposes of publicity, illustration, commercial art, advertising, publishing (including publishing in electronic form in CDs or internet websites), for any product or services, or other lawful uses as may be determined.

I further waive any and all rights to review or approve any uses of the images, any written copy or finished product. I am of full legal age and have read and fully understand the terms of this release.

Description of images:

_______________________________

Customer: ____________________________

Photographer: Sara Slavin

Date: ___________________