Julisa Marquez Photography

MINOR MODEL RELEASE FORM

Please fill out the form and send it before the photo session.

The parent or legal guardian listed below *

First

Middle

Last

Is granting permission to Julisa S. Marquez (or the professional photographer designed by her) to make photographs of the following minor/s *

First

Middle

Last

First

Middle

Last

First

Middle

Last

I warrant that I am of full age and have every right to contract for the minor(s) in this regard. I state further that I have read the above authorization, release, and agreement, prior to its execution, and that I am fully familiar with its contents. *

Relationship with the minor/s. *

Parent
Legal Guardian
School
Other

If other please explain

FOR VALUABLE CONSIDERATION: I hereby confer to Julisa S. Marquez on today's date (date listed at the end of this document), the absolute and irrevocable right and permission with respect to the photographs that she has taken of my minor child in which she may be included with others: A) To copyright the same in Julisa S. Marquez‘s name or any other name that she may select; B) To use, re-use, publish and re-publish the same in whole or in part, separately or in conjunction with other photographs, in any medium now or hereafter known, and for any purpose whatsoever, including (but not by way of limitation) illustration, promotion, advertising and trade, and; To use my name or my child’s name in connection therewith if she so decides. C) I hereby release and discharge Julisa S. Marquez from all and any claims and demands ensuing from or in connection with the use of the photographs, including any and all claims for libel and invasion of privacy. This authorization and release shall inure to the benefit of the legal representatives, licensees and assigns of photographer Julisa S. Marquez as well as the person(s) for whom she took the photographs. I have read the foregoing and fully understand the contents hereof. I represent that I am the [parent/guardian] of the above named minor/s. Finally: For agreement, trade deal, and/or value received, I hereby consent to the foregoing on her behalf. *

Parent/guardian email address *

Parent/guardian phone number *

NOTICE: PLEASE ONLY NUMBERS. DO NOT INCLUDE DASHES OR ANY SORT OF SYMBOL.

Electronic Signature and date *

First

Last

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