I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH Vacanva, a portrait session on location at the agreed upon location, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. I certify that I am physically fit, have sufficiently prepared or trained for participation in this activity, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity. In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, THE FOLLOWING ENTITIES OR PERSONS: Vacanva.com (Siegert Media, LLC and its representatives as well as the location where the portrait session is held and it's representatives and/or their directors, officers, employees, volunteers, representatives, and agents, and the activity holders, sponsors, and volunteers; (B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise. Page 2 of 2 I acknowledge that they are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. I acknowledge that this activity may involve a test of a person's physical and mental limits and carries with it the potential for death, serious injury, and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, lack of hydration, and actions of other people including, but not limited to, participants, volunteers, monitors, and/or producers of the activity. These risks are not only inherent to participants, but are also present for volunteers. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity. I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns. The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.
I hereby assign full copyright of these photographs to the above-mentioned photographer (and the related
representatives and assigns) together with the right of reproduction either wholly or in part.
I grant to the Photographer or licensees or assignees the permission to can the above-mentioned
photographs either separately or together, either wholly or in part, the perpetual and irrevocable and
unrestricted right to use and publish video and/or photographs of me, or where I may be included for
editorial trade, product advertising and such other fashion /business purpose in any manner and medium.
The Photographer and licensees or assignees may have unrestricted use of these for whatever purpose,
including advertising, with any retouching or alteration without restriction.
I agree that the above mentioned photographs and any reproductions shall be deemed to represent an
imaginary person, and further agree that the Photographer or any person authorized by or acting on his or
her behalf may use the above mentioned photographs or any reproductions of them for any advertising
purposes or for the purpose of illustrating any wording, and agree that no such wording shall be
considered to be attributed to me personally unless my name is used.
Provided my name is not mentioned in connection with any other statement or wording which may be
attributed to me personally, I undertake not to Prosecute or to institute proceedings, claims or demands
against either the Photographer or his or her agents in respect of any usage of the above mentioned
photographs. I hereby release the photographer named above from all claims and liability relating to
images, video or photographs taken of me.
I have read this model release form carefully and fully understand its meanings and implications.