Model Release for Birth Center Clients

Name *
Name
Date *
Date
I hereby assign full copyright of these photographs to the above-mentioned photographer Jessica Worland with the right of reproduction and distribution. I grant the photographer and The Birth Center of Bloomington-Normal the right to take, use, and publish photographs, which contain client’s image according to the following specifications *
Select One
I grant the photographer Jessica Worland and The Birth Center of Bloomington-Normal the right to use and publish video and/or photographs that meet the above criteria *
Select all that apply