Photography, Video and Testimonial Release Form

  • I, hereby grant to Breg, Inc. the irrevocable and unrestricted right and permission to copyright and use, re-use, publish, and re-publish photographic portraits, pictures, video of me, or testimonials, written or on video, of me, or in which I may be included, in whole or in part, or composite or distorted in character or form, without restriction as to changes or alterations, in conjunction with my own or a fictitious name, or reproductions thereof in color or otherwise, made through any medium and in any and all media now or hereafter known for illustration, promotion, art, editorial, advertising, trade, or any other purpose whatsoever, I also consent to the use of any printed matter in conjunction therewith.

    I hereby waive any right that I may have to inspect or approve the finished product or products and the advertising copy or other matter that may be used in connection therewith or the use to which it may be applied.

    I hereby release, discharge and agree to save harmless Breg, Inc. from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of said picture or in any subsequent processing thereof, as well as any publication thereof, including without any limitation any claims for libel or invasion of privacy.

    I hereby warrant that I am of full age and have the right to contract in my own name.  I have read the above authorization, release, and agreement, prior to its execution, and I am fully familiar with the contents thereof.  This release shall be binding upon me and my heirs, legal representatives, and assigns.

  • Clear Signature