Mother's Name *

First Name

Last Name

Mobile Number *

(###)

###

####

Aknowledgement *

Please acknowledge that your answers could be published online or in print for others to see, either wholly or just in parts.

Agree

Disagree

Adult Model Release *

In consideration of my engagement as a model, upon the terms herewith stated, I hereby give to Miranda Longoria of Miranda Longoria Photography her heirs, legal representatives and assigns, those for whom Miranda Longoria is acting, and those acting with her authority and permission: a) the unrestricted right and permission to copyright and use, re-use, publish, and republish photographic portraits or pictures of me or in which I may be included intact or in part, composite or distorted in character or form, without restriction as to changes or transformations in conjunction with my own or a fictitious name, or reproduction hereof in color or otherwise, made through any and all media now or hereafter known for illustration, art, promotion, advertising, trade, or any other purpose whatsoever. b) I also permit the use of any printed material in connection therewith. c) I hereby relinquish any right that I may have to examine or approve the completed product or products or the advertising copy or printed matter that may be used in conjunction therewith or the use to which it may be applied. d) I hereby release, discharge and agree to save harmless Miranda Longoria, her heirs, legal representatives or assigns, and all persons functioning under her permission or authority, or those for whom she is functioning, from any liability by virtue of any 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 thereof, including without limitation any claims for libel or invasion of privacy. e) I hereby affirm that I am over the age of majority and have the right to contract in my own name. I have read the above authorization, release and agreement, prior to its execution; I fully understand the contents thereof. This agreement shall be binding upon me and my heirs, legal representatives and assigns.

Agree

Disagree

Child Model Release *

For valuable consideration, I hereby confer on Miranda Longoria of Miranda Longoria Photography the absolute and irrevocable right and permission with respect to the photographs that she has taken of my minor child in which she may be included with others: a) To copyright the same in Miranda Longoria name or any other name that she may select; b) To use, re-use, publish and re-publish the same in whole or in part, separately or in conjunction with other photographs, in any medium now or hereafter known, and for any purpose whatsoever, including (but not by way of limitation) illustration, promotion, advertising and trade, and; c) To use my name or my child’s name in connection therewith if she so decides. I hereby release and discharge Miranda Longoria from all and any claims and demands ensuing from or in connection with the use of the photographs, including any and all claims for libel and invasion of privacy. This authorization and release shall inure to the benefit of the legal representatives, licensees and assigns of photographer Miranda Longoria as well as the person(s) for whom she took the photographs. I have read the foregoing and fully understand the contents hereof. I represent that I am the parent and/or gaurdian of the above named model(s). For value received, I hereby consent to the foregoing on his/her behalf.

Agree

Disagree