Model/photo/image Release

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Arts In Action
Consulting Firm
MODEL/PHOTO/IMAGE RELEASE
In exchange for consideration received, I hereby give permission to:
ARTS IN ACTION CONSULTING LLC
to use my name and
photographic likeness in all forms and media for advertising, trade,
and any other lawful purposes.
Print Name:_____________________________________
Signature:_______________________________________
Date:______________________Email address:_________________
Witness to the above signature:____________________________
Witness Email Contact:_____________________________
If Model is under 18:
I, __________________________________, am the parent/legal
guardian of the individual named above, I have read this release and
approve of its terms.
Print Name:______________________________________
Signature:_______________________________________
Date:_________________________________
Witness to the above signature:____________________________
Witness Email Contact:_____________________________
Revised January 2013
Model Release form for Arts In Action Consulting, LLC

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