Parent/Guardian Name

First Name

Last Name

Child Name

First Name

Last Name

Child Name

First Name

Last Name

Email

Phone

(###)

###

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Date

MM

DD

YYYY

MODEL RELEASE

I give permission to Carly Jara of Carly Jara Photography to use my child's image for promotional purposes on her website, social media pages, and/or printed promotional materials. I understand that my child's name will never be used.