Lucy Mallory Styling | Model Release Form

LUCY MALLORY STYLING

Lucy Mallory | (515)705-8592 | lucymallorystyling.com | @lucymallorystyling
MODEL RELEASE FORM
In exchange for consideration received I
Full Name
hereby grant Lucy Mallory irrevocable permission to publish photographs and video of me taken at:
Location:
Shoot Location
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearShoot Date
Furthermore, I will hold harmless the afore mentioned stylist Lucy Mallory from any liability use, reuse, publish and republish the photographs and video in whole or in part for non-commercial purposes for portfolios such as printed book or website, and social medias. I have read this release and fully understand its implications.
Model's Name:
Full Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone:
Format: (000) 000-0000.
Model's Signature:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate Signed
Should be Empty: