Model Waiver & Release Form

Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Area Code Phone Number

Email *

example@example.com

How did you hear about us? *

Instagram Google Facebook Family Friend Walk-in

Social Media Handle *

Instagram and/or Facebook

I authorize my licensed cosmetologist, to perform professional hair styling and photos. I have been fully informed as to the methods and techniques concerning this process. It has been represented to me that no guarantees, warranties, promises, commitments, or other statements as to the results of this service have been made, and I acknowledge that I have received no particular representations or guarantees, and I am consenting to the procedure at my own risk. I have revealed or disclosed all conditions and circumstances regarding my health and health history, medications being taken, and any past reactions to products used or medications are taken.

I, as herein signed, release, give up, acquit, and discharge my cosmetologist or any affiliates including any partnership, corporations, or company associated with SummersANDFall from any claims or damages of any nature.

Please read and check YES, to indicate that you have read, understand, and accept the following statement:

I, the client herein signed, certify that I have read and had explained to me and fully understand the above Waiver and Release Form. I certify that I have consulted with the cosmetologist and have read all applicable literature given to me. I certify I am of sound mind, and I am fully capable of executing this waiver and release form for myself. I, the undersigned client, acknowledge and fully understand that there might be other unknown risks not reasonably foreseeable at this time. I, the client herein signed, for the purposes of documentation, hereby consent to “before and after” photographs. *

Yes

I, the client herein signed, hereby give the absolute right and unrestricted permission to take, use, and display photographic images of me, through any form of media (print, electronic, broadcast, or otherwise) at any location for art, advertising, media release new articles, marketing, publicity, archival, or any other lawful purpose. I waive any right to royalties or other compensation arising from or related use of photographic images of me. *

Yes

Signature *

Clear

Today's Date

Date

SummersANDFall Model Waiver & Release Form