Fill and Sign the Use Likeness 497331896 Form

Grant of Right to use Photographic Likeness of Minor for Advertising Purposes The undersigned       , hereinafter called Minor, by (Name of Minor) and through his/her parents       and/or (Name of Mother)       , of       , (Name of Father) (Street Address, City, County, State, Zip Code) do hereby grant permission to       , of (Name of Photographer)       , hereinafter called Photographer, to use and (Street Address, City, County, State, Zip Code) sell to others photographs taken of Minor, proofs of which are attached and initialed by the undersigned, for advertising purposes, in consideration of $       , the receipt of which is hereby acknowledged. On behalf of Minor, we relinquish and give to Photographer all right, title, and interest that Minor may have in the finished pictures, negatives, reproductions, and copies of the original prints and negatives, and further grant such Photographer the right to give, sell, transfer, and exhibit the negatives, original prints, and copies or facsimiles of them, for advertising purposes, to any responsible individual, business firm, or publication, or to any of their assignees. Witness my/our signature(s) this       day of       , 20       .       (Name of Minor) By: (Signature of Father or Guardian)       (Printed Name of Father or Guardian) By: (Signature of Mother or Guardian)       (Printed Name of Mother or Guardian) Grant of Right to use Photographic Likeness or Minor for Advertising Purposes Page 1 of 2 Grant of Right to use Photographic Likeness or Minor for Advertising Purposes Page 2 of 2