Kerry Kassinger Photography
PO Box 214
Madisonville, KY  42431
Phone - (270) 841-7021
kerrykassinger@bellsouth.net


COPYRIGHT RELEASE 



I, ____________________________________, Owner of  Kerry Kassinger Photography do hereby give 

__________________________________________,  permission to copyright and/or use, and/or publish
1 (One) photographic portrait or picture of model.  I hereby waive any right that I may have to 
inspect and approve the finished product or copy that may be used in connection with an image 
that the Photographer has taken of said model, or the use to which it may be applied.
 


Model's Name ___________________________________________________(print)


Model's Signature ______________________________________ Date _________
 

Model's Address _______________________________________________________
 

Model's Phone _____________________________________  Image #___________

Model's E-mail Address _________________________________________________ 



The undersigned Photographer does hereby grant to the Model permission to display, and/or use, and/or 
publish photographic portrait or picture, and/or digital information pertaining to them, in still, 
single, multiple, moving or video format, or in which the Model may included in whole or in part, 
or composite, or distorted in form, or reproductions thereof, in color or otherwise, made through 
any media for lawful promotion of the Model as long as the copyright of the Photographer is clearly 
presented with the image.



Photographer's Signature ___________________________________________
 

Witness ____________________________________________________________ 


This Release shall not be used more than 1 (One) time by model.