Model Release Form

Model Release Form

Full Name: Lena Lu Willis

Address: 15 Danesmoor Crescent, Darlington

Telephone Number: 07581535276

Shoot Location: Queen Elizabeth Sixth Form College

Date: 11/02/14

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: Lena Willis