Name of Model/Client *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Date of Session

MM

DD

YYYY

Parent of Guardian agreement for Minor

Minor Model Release For valuable consideration, I hereby confer on LK Supreme Media Studio the absolute and irrevocable right and permission with respect to the photographs that he/she has taken of my minor child in which he/she may be included with others: a. To copyright the same in LK Supreme Media Studio 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; c. To use my name or my child's name in connection therewith if he/she so decides. I hereby release and discharge LK Supreme Media Studios 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 LK Supreme Media Studios as well as the person(s) for whom he/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. For value received, I hereby consent to the foregoing on his/her behalf.

First Name

Last Name

By Checking this box you agree to the above terms regarding your photo Session with LK Supreme Media Studios *

I AGREE