Model Release

Model or Stage Name*
Model's Legal Name*
When images are published in a magazine, use this name*
When images are published on the web, use this name*
I want to be credited when images are on the web*
 Yes No

 I understand, that once images are on the web, I can not change the name or have them removed*

Email*
Phone*
Address with Zip*
Website

For valuable consideration as listed below, I hereby give the photographer Nina Pak, her legal representatives and assigns, the right and permission to Copyright and / or use, publish and reuse and republish photographic pictures, portraits and /
or art made of me. Even if the images may be distorted in character or form, representing my own name or a fictitious name, through any media and for whatever purpose the photographer chooses. I hereby waive any right to approve the finished photograph or any copy which might be used in conjunction with the finished photograph.

I am over the age of 18, I am legally competent to contract in my own name*
 Yes No

If the model is under the legal age of 18, the parent's or guardian's signature is required.

Relationship to model:

 I hereby certify that I am the parent or guardian of this model and I agree to the terms as laid out above.

 I have read the foregoing release, authorizations and agreements before affixing my signature below, and warrant, that I fully understand the contents thereof.*

Accepted and agreed to date*

I accept the terms of this Model Release*

Please attach a scan or photo of your valid ID*

Model or Model's guardian signature*