Model Release Form Name * First Name Last Name Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Session Date * MM DD YYYY Model Release * For valuable consideration I hereby give to TRACY CEPELAK of TRACY LYNN PHOTOGRAPHY the absolute and irrevocable right and permission with respect to the photographs that she has taken of myself and/or my minor child(ren) in which he/she may be included with others present at the photography session: a) To copyright the same in the photographer’s 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, I hereby release and discharge photographer 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 the photographer 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/guardian] of the above named model(s). For value received, I hereby consent to the foregoing on his/her behalf. Yes No Please confirm * I give permission to use photos from our session on Tracy Lynn Photography blog/website, social media accounts (Facebook and Instagram) and marketing/promotional materials Yes No Names of all children being photographed * Name * An electronic signature shall be given the same effect as a written signature First Name Last Name Thank you!