Model Release

In consideration of my own / my child's (circle one or both) engagement as a model, and for other good and valuable consideration herein acknowledged as received, I hereby grant to Logan Powell and Helen's Children's Shop, heirs, legal representatives and assigns, those for whom Logan Powell and Helen's Children's Shop is acting, and those acting with her authority, and permission, the right and permission to copyright, in her own name or otherwise, and use, re-use, publish, and re-publish photographic portraits or pictures of me / my child (circle one or both) in which I / my child (circle one or both) may be included, in whole or in part, or composite or form, without restriction as to changes or alterations or reproductions thereof in color or otherwise, and in any and all media now or hereafter known for illustration, promotion, art, editorial, trade for the purpose of advertising products that are for sale at Helen's Children's Shop. 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 Logan Powell and Helen's Children's Shop, her heirs, legal representatives and assigns, and all persons acting under her permission or authority or those for whom he/she is acting, from any liability by virtue of any blurring, 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 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 or the name of my child. 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.

Date:

Model's Name:

Parent's Name (if model is under 18 years old):

Legal Signature (Parent / Model, circle one):

Address:

City, St, Zip:

Witness Name:

Witness Signature:

Please sign and return to:

Helen's Childrens Shop
4102 Hillsboro Road
Nashville, TN 37215