Studio Picture Order Form

Student Name:

Student's Class:

Best email to send photos:

Photo Pricing:
$30 Photo Package
$15 Single Individual Photo
$15 Single Group Photo

Photo Order:
Photo PackageSingle Individual PhotoSingle Group Photo

Method of Payment:
—Please choose an option—I will Venmo payment to Winnie-Ross-2I will send cash with my student

OFFICIAL PHOTOGRAPHY WAIVER RELEASE
Montage Creations Mondovi, WI | 715-577-1946

I hereby grant the releasee permission to use photographs in any of the following:

Web-based Applications
Social Media
Print Advertisements

Yes, I consent to media release.No, Please do not use my photos.

I hereby affirm that such release to the releasee does not constitute any form of compensation,
including royalties arising from the photographs to my benefit. I understand and agree that photographs
in the possession of the releasee shall become the property of the releasee. The use and publication of
the photographs, however, shall conform to my rights as a subject of said photographs.
I hereby waive my right to inspect of approve the photographs by which my likeness appears. I hereby
hold harmless, release, and forever discharge the Montage Creations/Winnie Palad Ross from all claims,
demands, and causes of action which I, my heirs, representatives, executors, administrators, or any
other persons acting on my behalf or on behalf of my estate have or may have by reason of this
authorization.

—Please choose an option—I am of legal ageI am a minor and represented by a parent or guardian

I declare true my age of consent, and in case I am under the age of such consenting age, I have obtained the required consent from my parents/guardians as evidenced by the signatures below:

Parent/Guardian Name:

Parent/Guardian Signature: