MINOR RELEASE

MINOR MODEL/PERFORMER RELEASE AGREEMENT
Date/s of production/s:              05/5/17              

Photographer name:                                  Tom Moore

Talent:                                            

Address:                                         W9  

Phone No:                  07747017130                        

Age of Talent (at time of production):              16

Description of production/s:             screen capture reecording                                  

I hereby grant to                        (“Photographer”), the absolute right and permission to
take, use, reuse, publish, and republish the minor’s image, this will include the use of the image
or likeness on one of the College’s YouTube or Vimeo channels or official website.
I hereby agree that I am over 18 years of age and have every right to sign for the minor. I state
further that I have read this release and that I am fully familiar with its contents.
Parent or Guardian’s Signature:                                                                   
                       
Parent/Guardian Name:                  Chris Moore                                    

Email address:                                                          

Parent or Guardian phone (if differs from minor)                            07745024160

Witness Signature              K.moore                                 


Witness Name(print):                       KEITH MOORE