EmailMe Form - Studio 1004 Model Application

Student Model Name *

First Last

High School Name *

Class Year *

Model's email *

Model's cell # *

Parent/Guardian Name *

Parent/Guardian cell # *

Mailing Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

My friends would describe me as...

My mom would describe me as...

I describe myself as...

Nominate a high school junior you think would love to be a model. *

Pre-Photo Shoot Options

For marketing and promotional purposes, we will need to conduct a photo shoot PRIOR to your actual session. This is a FREE session, limited to 2 outfits. This session must be done my March 31st. List your top three choices for your promotional shoot. Must be Tues-Fri 10a-5p.

Date Time

MM / DD / YYYY

Date Time

MM / DD / YYYY

Date Time

MM / DD / YYYY

I understand, as a model, Studio | 1004 can use the images from my sessions for any and all advertising purposes. *

YES

I understand, as a model, my senior portraits MUST be taken at Studio | 1004 before June 31. *

YES

I understand that this is a binding contract with Studio 1004. If I fail to return to Studio 1004 before June 31 for my senior portraits, I will be billed $250 for loss of time and portraits. *

YES

Parent/Guardian Signature *

Model's Signature *

Today's Date

MM / DD / YYYY

Attach a photo of yourself. *