ArMack Orchestra Photo Model Release Form

I, ___________________________________hereby authorize and give my full consent

(Print Name)
to the Armack Orchestra to copyright, reproduce, and publish photographs taken of me,
and my music, in any printed material, or on their website, in which:
My minor son,__________________________________________________________
(Print Name)
My minor daughter,______________________________________________________
(Print Name)
My ward,______________________________________________________________
(Print Name)
And/or I, ________________________________________________________appear.
(Print Name)
I further agree that the Armack Orchestra may use or cause to be used, my music and
photographic images for any and all publications, displays, and advertising purposes,
without limitations or reservations or any compensation other than that receipt of which
is hereby acknowledged.
I declare that I am

[ ] over the age of 18

[ ] the legal guardian of the following,

If legal guardian of model(s), please print name(s) here:_________________________

______________________________________________________________________
Signature

___________________________________________________________

Date

___________________________________________________________

Address_______________________________________________________________

______________________________________________________________________
Telephone

___________________________________________________________

Email:

___________________________________________________________

ArMack Orchestra
1720 M Street
Arcata, CA 95521
(707) 825-2400

9-20-09 lt