Dancer's Name *

First Name

Last Name

Current Team *

Middle School

JV

Varsity

Parent/Guardian Name *

First Name

Last Name

Phone *

(###)

###

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Select Your Photoshoot Package(s) *

Package #1 ($65)

Package #2 ($75)

Package #3 ($85)

Package #4 ($95)

Sibling Friend Photo (2 Athletes - $20)

Sibling Friend Photo (3 Athletes - $27)

Sibling Friend Photo (4 Athletes - $35)

Model Release Form *

1. For valuable consideration, the adequacy of which is acknowledged, I irrevocably and absolutely consent to the unrestricted use by My Spirit Media (“Photographer”) it’s successors, assigns, and designees and those acting with their permission and authority, of my name and any and all photographic or other images (“Images”) of me that My Spirit Media creates or makes, for all purposes, in any form, in conjunction with my own or a fictitious name, and in any and all media. 2. I waive any right to inspect or approve the finished Images or printed matter that may be used therewith, or to the eventual use that the Images may be applied. 3. I hereby forever release and discharge My Spirit Media, their legal representatives, agents, assigns and the party for whom the Images were made, from any and all claims, actions and demands arising out of or in connection with the use of said Images. 4. I hereby affirm that I am over the age of majority and have the right to contract in my own name. I have read the above release and agreement, prior to its execution; I fully understand the contents thereof. This agreement shall be binding upon me and my heirs, legal representatives and assigns. 5. ASSUMPTION OF THE RISK. I acknowledge and understand the following: 1. Participation includes possible exposure to and illness from infectious diseases including but not limited to COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist and; 2. I knowingly and freely assume all such risks related to illness and infectious diseases, such as COVID-19; and 3. I hereby knowingly assume the risk of injury, harm and loss associated with the Activity. Please type your name below as an electronic signature to agree to the above.

First Name

Last Name

Check box below if you have read and agree to the above *

I Agree