Model Release Form

First name:

Last name:

Address:

Address Line 2:

City, State, Zip code:

Country:

Phone Number:

Email:

I give Cindy Langford permission to photograph my child on the date listed below.

I give permission to use photos taken during the photoshoot on the date listed below in promotional materials such as facebook, website & brochures.

Please DO NOT tag my child in facebook photos.

Date of Photoshoot:

Electronic Signature*:

Todays Date: