Model Release

 Effective as of the date shown below, approval for past use and permission for present and future use is being granted to Nate Crouch Photography and Visit Hendricks County, 8 West Main Street, Danville, Indiana 46122 to use photographs or other images taken on the date below of the model named below (the Photographed Party), as more fully explained in this Consent and Release. The Photographed Party is an adult and is fully authorized to sign this Consent and Release.

For value received, receipt of which is hereby acknowledged, the Photographed Party hereby grants consent to Nate Crouch Photography and Visit Hendricks County, its agents, employees, licensees, and successors in interest (collectively, the Released Party) and authorizes the use of any and all photographs taken of the Photographed Party, and any reproduction of them in any form in any media whatsoever and in any derivative work based thereon throughout the world, and to use them to publicize, promote and advertise, including but not limited to use for point of sale advertising.

The Photographed Party also consents to the use of their own name or any fictitious name which may be chosen in connection with the aforesaid photographs.

The Photographed Party hereby releases any and all claims whatsoever in connection with the use of their photograph and name and the reproduction thereof as aforesaid.

The Photographed Party hereby waives any right that they may have to inspect and/or approve the Book or the advertising copy that may be used in connection therewith or the use to which it may be applied.

THE PHOTOGRAPHED PARTY WARRANTS THAT THEY ARE THE UNDERSIGNED AND THAT THEY HAVE READ THIS CONSENT AND RELEASE PRIOR TO THE SIGNING OF THIS DOCUMENT, THAT THE UNDERSIGNED UNDERSTANDS IT, AND THAT THE UNDERSIGNED FREELY ENTERS INTO THIS CONSENT AND RELEASE.

By submitting this form I the Named Below of the address listed below do intend of being legally bound on the date listed below.