Thank you for your consideration in providing us permission to use your image.  Please fill out the form below.  Your image may be used on other literature other than our website or may not be used at all. 

Name *
What school do you go to?
I provide you with permission to use my senior portrait images on your website *
Age *
Parent's Permission
If you are under at year's old, do one of your parent's provide use with persmission to use your images on our website?
In consideration of the engagement as a model of the minor/adult (if over 18 years old) named above, and for other good and valuable consideration that I acknowledge as having received, I hereby grant the following rights and permissions to Joe Photographer ("Photographer"), his/her legal representatives and assigns, those for whom Photographer is acting, and those acting with his/herauthority and permission. They have the absolute right and permission to take, use, reuse, publish, and republish photographic portraits or pictures of the minor or in which the minor may be included, in whole or in part, or composite or distorted in character or form, without restriction as to changes or alterations from time to time, in conjunction with the minor's own or a fictitious name, or reproductions of such photographs in color or otherwise, made through any medium at Photographer's studios or elsewhere, and in any and all media now or hereafter known, including the internet, for art, advertising, trade, or any other purpose whatsoever. I also consent to the use of any published matter in conjunction with such photographs. I specifically consent to the digital compositing or distortion of the portraits or pictures, including without restriction any changes or alterations as to color, size, shape, perspective, context, foreground or background. I waive any right that I or the minor may have to inspect or approve any finished product or products or the advertising copy or printed matter that may be used in connection with such photographs or the use to which it may be applied. I release, discharge, and agree to hold harmless and defend Photographer, his/herlegal representatives or assigns, and all persons acting under his/herpermission or authority or those for whom he/she is acting, from any liability by virtue of any reason in connection with the making and use of such photographs, including blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of said picture or in any subsequent processing thereof, as well as any publication of them, including without limitation any claims for libel or violation of any right of publicity or privacy. I hereby warrant that I am a legal competent adult and a parent or legally appointed guardian of the minor, and that I have every right to contract for the minor in the above 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 the contents of it. This release shall be binding upon the minor and me, and our respective heirs, legal representatives, and assigns.