Model Release Form

Company Name: __Love Chester Magazine__

I, the model ___ELLA CLANCY___ (write full name)

Mobile No: ___07864579217____

Email: ______eclancy@gmail.com_____ (all in lower case)

Location: Chester International School, Queen's Park Rd, Handbridge, Chester CH4
7AE___

I hereby grant permission _Love Chester Magazine_ all rights of every kind for
photographs to be taken of me and used in a new magazine production. I authorise
_Love Chester_ magazine to copyright use and publish the same in print and/or
electronically.
I agree that _Love Chester_ magazine can use images of me with or without my
name for lawful purpose such as for publicity and illustration.

I have read and understood the above:

Signature ………………………………………………………………

Date ____16/12/2020____