Child's Name *

First Name

Last Name

*Minor Release

I grant Regina Hickman and Elemental Lens Photography permission to use, e-use, publish and re-publish the same in whole or in part, separately or in conjunction with other photographs, as it is now or any other editing photographer chooses in the future and in any medium now or hereafter known, and for the purposes including, but not by way of limitation, promotion, advertising, web publishing, social media publishing and printed marketing collateral. Elemental Lens Photography agrees to use said images for the sole and exclusive purpose of promoting family, school and child photography in pertinent markets. My child's name will never be published.

I hereby release and discharge photographer from all and any claim and demands connected to any compensation for such usage.

*Digital Signature

By typing my name in the box following this I understand that it is my digital signature giving consent.

Parent/Gaurdian Name *

First Name

Last Name

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country