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I hereby irrevocably consent to the unrestricted publishing, photographing, videotaping or otherwise recording or broadcasting of my photographs, video, image or likeness by the boutique owner or designer booking a model at Moda

I further agree that I own the copyright to all photos submitted to Moda Munchkin which may also appear on the Moda Munchkin website; advertising to include promotional advertising; Kids in Print magazine; and/or social networking sites such as, but not limited to, Facebook.

A model over the age of 18 does not need parental consent, but does need to agree to the model release/media consent form.

Full name of parent:
(model if over 18)

Full name of model:


Contact phone number:



I consent to the above:
(please type I Consent)

If you do not consent to this form, please click here.


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All Rights Reserved.