Model Subject Release Form printable pdf download

Model Subject Release Form

Model / Subject Release Form

Persons over the age of 18 may sign for themselves; persons under 18 must have this

release signed by their parent or guardian.

I hereby consent to the use of this/these images(s) of my child/dependent/self, and/or

any copies of this/these photograph(s) in any editorial and/or promotional material

produced and/or published by Kevin Patton, St. Charles Community College,

(Lion Den Inc.), or their agents or assignees.

I understand that signing this release does not guarantee publication of the images(s).

Name of model or subject

___________________________________

Name (Parent/Guardian if model is under 18)

___________________________________

Signature (Adult or Parent/Guardian):

___________________________________

Name of witness (over 18)

___________________________________

Signature of witness

___________________________________

Date: _______________

(please attach photocopy/photocopies [with this model identified on the copy] of material

to this form)

(please keep a copy for your own records)

Model Subject Release Form