Download as pdf or txt
Download as pdf or txt
You are on page 1of 1

The Learning Connexion | Model Release Form

The Learning Connexion


Model Release Form – Please return this form to Reception Page 1 / 1

In exchange for consideration received, I hereby give permission to The Learning Connexion
to use my name (if applicable) and photographic and/or painted and/or drawn and/or
sculptural likeness in all forms and media for advertising, trade and any other lawful
purposes.

Name:

Address:

I confirm that I am 18 years of age or older.

Signature:

Date:

182 Eastern Hutt Road, Taita, Lower Hutt 5019


0800 ART POWER (278 769)
tlc.ac.nz

You might also like