Model Release Full Name * First Name Last Name * Last Name Address * Address Street Address Street Address Street Address Line 2 Street Address Line 2 City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Phone Number * Email * I hereby grant permission to Care-In-Home LLC (d/b/a Household Staffing, Quilty's Newborn Care), to use photograph(s) I have provided for the purpose of printed documents, websites, and social media. I acknowledge that my participation is voluntary and that I will not receive financial compensation. I further agree that providing my photograph(s) confers upon me no rights of ownership whatsoever. I understand that the photograph(s) I provide may be edited, copied, exhibited, published or distributed, and I waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph(s). I hereby hold harmless and release and forever discharge Household Staffing 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. I am over the age of 18 and have read and understood the terms of this release. I agree * I have read and understand the terms of this model release Signature * Clear If you are human, leave this field blank. Submit Δ