Your Name (required) Legal Guardian (if under 18) Your Email (required) Your Telephone Number (required) Your Address (required) Date of Session (required) Model Release I hereby give to Life Times Visual Media/Kimberly Dyann Photography/Replete Columbus the absolute and irrevocable right and permission with respect to the photographs that he/she has taken of myself and/or my minor child in which he/she may be included with others: a) To copyright the same in the photographer’s name or any other name that he/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; 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. I have read and understand the terms of this model release. Type Full Name of Model or Legal Guardian(required)