Model Release Form

Model Release Form

Full Name: Amelia Tara Hanspal

Address: 142 Coniscliffe Road, Darlington

Telephone Number: 07519661727

Shoot Location: Manor House

Date: 12/10/13

I hereby give Jordan Richards, the irrevocable and unrestricted right to use and publish video footage or photographs of me that are taken on the above date. These may be used for educational purposes (that may include publishing to a public video forum, such as Youtube or a blog), film production or advertising.

Print Name: Amelia Hanspal