Free Holiday Photo Request Form & Model Release


Name of Photographer: Geoffrey (Jack) Cox


Dear Jack,

I / We are holidaying on the Costa del Sol and would like you

to join me/us for a few hours on ............................2005 to 
photograph me/us having fun.

Please send me a free copy of each photograph that you take of me/us that day
at:............................................................... (place)

I understand that I will never be asked for any money or contacted as part of
any sales promotion.  My personal details will only be retained for the sole
purpose of identifying me/us as the person(s) in this / these photograph(s).

In exchange for the free photograph(s) I/we agree to the following conditions: 
I/we irrevocably consent to and authorise the use and reproduction by you
(Geoffrey Jack Cox), or anyone authorised by you, of any and all photographs
which you have of me on the date(s) specified above, negative or positive, 
mechanical or electronic, for any purpose whatsoever, without restriction, 
and without further compensation to me. All negatives, positives, electronic 
files, together with any prints shall constitute the photographer’s property,
solely and completely. I hereby release, discharge and save harmless the 
photographer, his representatives, assigns, employees, or any person or 
corporation acting under the permission of the photographer, including any firm 
publishing or distributing the finished product, even though the finished 
product may be distorted, blurred, altered or used in composite forms, 
in conjunction with factual or fictional text, either intentionally or 
otherwise in whatever way and for whatever purpose or intent. 

I hereby waive any right to approve the finished photograph or any wording
which might be used in conjunction with the finished photograph. 

I declare that I am over the age of eighteen and consent to the inclusion
of this standard Model Release form including the personal details contained
in it, being added to the public database owned or operated by the photographer, 
his agents or their subsidiaries and customers.

Please give details of everyone who is to appear in the photographs.  Where a
person is under 18 the signature should be that of the parent or legal guardian.


Name:............  Age if under 18:......   Signature:..........  Date:........

Name:............  Age if under 18:......   Signature:..........  Date:........

Name:............  Age if under 18:......   Signature:..........  Date:........

Name:............  Age if under 18:......   Signature:..........  Date:........

Name:............  Age if under 18:......   Signature:..........  Date:........


Home address:...................................................

My email address:...............................................

Digital files on a CD-Rom,Digital files by email.

(Please delete all which to not apply,  if this section is not completed clearly
the photographer will use his own judgment)

Please complete & sign this for and return it, either scanned, faxed,or by post, 
to the following:

Jack Cox
P.O. Box 42
Fuengirola
29640
Spain

FAX: +34 952486340
Email:  jack@travelpicspro.com