Media Release Form

First and Last Name of Model *

First and Last Name of Parent or Guardian

Email Address *

Phone *

Consent *

I, the undersigned, hereby consent to the use of my photograph or likeness in any publication, videotape, pamphlet or promotion by ADA Photography or other agencies which are promoting or furthering the mission of ADA Photography. I understand that I will not receive separate compensation or consideration from ADA Photography or anyone else for the permission granted in this Consent nor for the actual publication or use of my photograph or likeness. By signing this Consent, I understand I am releasing ADA Photography from any and all liability that may occur as a direct or indirect result of my photograph, the release of my identity, or the public relations materials, including but not limited to the use of any quotations.