Model Release Form

For valuable consideration received, I grant to _________ben ford___________________

("Photographer") and his/her legal representatives and assigns, the irrevocable and
unrestricted right to use and publish photographs of me, or in which I may be included, for
editorial, trade, advertising, and any other purpose and in any manner and medium; and to
alter and composite the same without restriction and without my inspection or approval. I
hereby release Photographer and his/her legal representatives and assigns from all claims and
liability relating to said photographs.

Ben ford

___________________________________________________ MODEL'S SIGNATURE

Ben ford

___________________________________________________ PRINT NAME

29th April 2002

___________________________________________________ MODEL’S DATE OF BIRTH

48 springbank way

___________________________________________________ 1 st LINE OF ADDRESS

Gl51 0pl

___________________________________________________ POSTCODE

5199753@student.gloscol.ac.uk

___________________________________________________ EMAIL ADDRESS

9th December 2020

___________________________________________________ TODAY’S DATE

___________________________________________________ LEGAL GUARDIAN SIGNATURE (if under 18)

___________________________________________________ PRINT NAME

9th December 2020

___________________________________________________ TODAY’S DATE