Senior Model Application

School _____________________________________ Class of ___________

Name_______________________________________________________________

Address ____________________________________________City___________________State ______Zip Code __________

Home Phone__________________________Cell Phone ______________________e-mail________________________________________

What type of extra curricular school activities (including clubs, sports and offices) are you involved with?

_______________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

My class_________________________________Phone______________Behind me_____________________________Phone_______________

My class ________________________________Phone ______________Behind me _____________________________Phone_______________

As a Senior Model, you are not allowed to work on any studio assignments while in class. All studio assignments should be worked on during your

study hall, lunch, before or after school or any free time you may have.

___________________________________________

Signature of applicant

I give my permission for my son or daughter to be your Senior Model/Rep

and to help promote Forrestal Portrait Gallery. I also grant permission to Forrestal Portrait Gallery

and your licensees or assignees to use portraits (including their name) for

unrestricted (unless noted) advertising, promotions, web site,

competitions and display purposes. I understand that the photographs

will be selected as needed by Forrestal Portrait Gallery and that I will not be notified

each time they are used.

___________________________________________

Signature of parent or guardian

Please fill out and mail to: