Photo Release for Children Under 18 Years of Age I hereby grant to ______________________________ and to its employees, agents and assigns the right to photograph my dependent and use the photo and or other digital reproduction of him/her or other reproduction of his/her physical likeness in whole or in part for publication processes, whether electronic, print, digital or electronic publishing via the Internet. Model's Signature: Model's Printed Name: Address: I certify that I am a custodial parent and have the aforementioned rights to assign. Signature of
Print Name of Parent or Guardian: Address: Date: ______________________ |