Photo Release Form

I hereby give Active Aging Partnership the absolute right and permission to copyright and/or publish the photographic portraits or pictures of ___________________________. I agree that the photograph becomes the exclusive property of the Active Aging Partnership and I waive all rights hereto.

I waive all rights to inspect and/or approve copy that may be used in conjunction with the photograph and the use to which it may be applied.

The photograph–whole, in part, or composite–may be used as the Partnership sees fit in the publication of educational materials, for websites, and for any other lawful purposes.

Date: _________________

Model Name:________________________________



Phone number: _______________________________

May we contact you for more information about your physical activities?

Yes ___________
No ___________