Modeling Workshop Registration Form

Modeling Workshop Registration Form

Please fill in the form below. One person per form. Six week workshop. Begins Thursday, April 16th 6:00-7:30 pm
Full Name*

First NameLast Name
Age:*
MaleFemale
Parent (If Minor)
Parents Name
Phone Number*

Area CodePhone Number
E-mail*
Height (If Model):
Emergency Contact*

First NameLast Name
Emergency Contact Phone*

Area CodePhone Number
Billing Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
FacebookInstagramWebsiteEmailAmbiance StaffFriendOther
If referred by a friend or Ambiance Staff please list name:

$495 Total fee for Model Bootcamp. Deposit is $195 (Balance of $300 is due before first day of workshop).*

6 Week Workshop Deposit$195.00

Non - Refundable Registration Deposit

Remainder Due Prior to Start of Workshop$300.00

Remainder of 6 Week Workshop

Signature*
Release Agreement: As participant or parent / guardian of the above participant, I give my permission for myself or my child (if under 18) to participate in the acting and/or modeling workshop. I agree to indemnify and hold harmless Ambiance Models & Talent, Inc., its sponsors, instructors, coaches and employees against any loss, damage, injury or other conditions arising out of myself or my child’s participation. I understand that all registration fees are non-refundable. Also, in consideration of the potential for additional publicity, I hereby authorize use of my photos, video or television for future use and advertising.
Yes
Should be Empty: