2012 GLQ Photo Contest Model Release Form
I hereby grant permission to the Georgia Library Quarterly (GLQ) and their agents to use
photographs taken of me or my minor child(ren) on the date and at the location listed below for
use in publications, both printed and electronic, and in promotional PowerPoint/video
presentations, including public service announcements. I hereby waive any right to inspect or
approve the finished photographs or printed or electronic matter that may be used in conjunction
with them now or in the future, whether that use is known to me or unknown, and I waive any right
to royalties or other compensation arising from or related to the use of the photograph. I hereby
agree to release, defend, and hold harmless the Georgia Library Quarterly and their agents
including any firm publishing and/or distributing the finished product in whole or in part, whether
on paper or via electronic media, from and against any claims, damages or liability arising from or
related to the use of the photographs, including but not limited to any misuse, distortion, blurring,
alteration, optical illusion or use in composite form, either intentionally or otherwise, that may
occur or be produced in taking, processing, reduction or production of the finished product, its
publication or distribution. It is the discretion of the Georgia Library Quarterly to decide whether to
use the image(s). I have read this release before signing below, and I fully understand the
contents, meaning and impact of this release. I understand that I am free to address any specific
questions regarding this release by submitting those questions in writing to the Georgia Library
Quarterly prior to signing, and I agree that my failure to do so will be interpreted as a free and
knowledgeable acceptance of the terms of this release.
Event and Location of Photo:
_____________________________________________________
_____________________________________________________
Date:
_____________________________________________________
Name (please print):
_____________________________________________________
Signature:
_____________________________________________________
Signature of parent or guardian [if under 18 years of age]
_____________________________________________________
Resume Templates 1210 Document(s)
