AGREEMENT FOR PERMISSION TO USE PHOTO AND IMAGES AND RELEASE AND WAIVER

AGENCY 5 INC.

I by this release and waiver agreement (the “Agreement”) give my permission to Agency 5 Inc. to use my images and likeness, whether those images are portrayed or taken by photograph, drawing, video or otherwise, (“Content”) for its commercial purposes, including but not limited to promotion or education about it products, and for it general use. such general use shall include but not be limited to print media, internet, radio, television, or other publications. This information may be used by Agency 5 Inc. perpetually and throughout the world. I confirm that, as of this date of signing, I am eighteen years of age or older. I can revoke this permission and release at any time by providing written notice to Agency 5 Inc. sent by registered US Mail.

Release Provision

I understand and agree that the Images may be released to the public. Once released, this information is no longer protected and may be accessed by the public. Therefore, I hereby release and waive claims against Agency 5 Inc., it agents, employees, successors, representatives, assigns and contractors and any other persons involved with taking or producing the Content (“Released Parties) from any and all liability which may or could arise therefrom as follows:

I grant to Agency 5 Inc. the absolute and irrevocable right and unrestricted permission concerning any of the Content, to use, reuse, publish, and republish the photographs in whole or in part, individually or in connection with other material, in any and all media now or hereafter known, including the internet, and for any purpose whatsoever, specifically including illustration, promotion, art, editorial, advertising, and trade, without restriction as to alteration; and to use my name in connection with any use, if Agency 5 Inc. so chooses.

I release and forever discharge Released Parties / Agency 5 Inc. from any and all claims and demands that may arise out of or in connection with the use of the Content, including without limitation any and all claims for libel or violation of any right of publicity or privacy. This authorization and release shall also inure to the benefit of the successors, heirs, legal representatives, licensees, and assigns of Agency 5 Inc., as well as the person(s) or entities for whom the photographs were taken. I am a legally competent adult and have the right to contract in my own name. I have read this document and fully understand its contents. I have had an opportunity to consult counsel.  This release shall be binding upon me and my heirs, successors, legal representatives, and assigns.