In consideration of compensation as indicated below, receipt of which is hereby acknowledged, I ________________________________ (hereafter "Model"), and ________________________________ (hereafter "Parent") as Model's parent or legal guardian, do hereby irrevocably authorize Timothy M. Dolan Jr. (AKA Longwatcher) (hereafter "Photographer"), Photographer's legal representatives, assigns, and those acting under Photographer's permission and on Photographer's authority, to copyright, publish, and use in all forms and media and manners for advertising, trade, promotion, exhibition, or any other lawful purpose whatsoever, any depictions of Model made by Photographer or Photographer's representative and captured on _______________, in which Model may be included in whole or in part, alone or in conjunction with other persons, or composite or distorted in character, or form, or based on or involving any stunt poses, in conjunction with Model's own or a fictitious name, or reproductions thereof in color or otherwise, or in derivative works made through any medium, where said depictions may include any or all of still, single, multiple or moving photographic images or pictures, video recordings or audio recordings (collectively hereafter the "Depictions.")

Model and Parent do hereby waive any right to inspect or approve the finished product or advertising or other copy that may be used in connection therewith or the use to which they may be applied.

Model and Parent hereby release and agree to hold harmless Photographer, his legal representatives, assigns, and all persons acting under his permission or authority, from any liability by virtue of blurring, distortion, alteration, optical illusion, or use in composite form whether intentional or otherwise, that may occur or be produced in the taking of the pictures, or in any processing tending toward the completion of the finished product, unless it can be clearly shown that the publication thereof were maliciously caused, and produced, and published solely for the purpose of subjecting Model to conspicuous ridicule, scandal, reproach, scorn, and indignity.

Model and Parent hereby affirm that all poses, positions and situations enacted in the Depictions covered in this release were entered into without force, coercion, or threat whatsoever, and were posed freely by Model with Model's and Parent's full consent in return for compensation and for Model's own amusement. Model and Parent further agree to hold blameless and free of all accusation of such force or coercion Photographer, his legal representatives, assigns, and those acting under his permission and on his authority.

Parent hereby affirms that he/she is the mother, father, or legal guardian of Model and that Model's date of birth is _____________ and that Parent's date of birth is ______________.

Parent hereby affirms that neither Model's nor Parent's execution of this instrument causes a breach of any prior agreement or applicable law, including but not limited to a prior agreement with a modeling agency, talent agency, or other photographer.

The compensation in connection with this instrument is:_________________________________________

We have read the above authorization and release prior to its execution and are fully familiar with and agree to the contents thereof.

Model’s Legal Name:________________________________________Model Name:_________________

Model’s Signature:_______________________________________________   Date:_________________

Parent’s Name:________________________________________________________________________

Parent’s Signature:________________________________________________Date:_________________

Address: Street:________________________________________________________________________

City:__________________________________________State:___________________ Zip:____________

Phone:________________________ Email:__________________________________________________