RELEASE

I, ________________________________________________________ parent/guardian

of ________________________________________________________, a minor, in

consideration for value received as per the one option selected below:

One 5”x7” print of the image.

One time $10 fee.

Other ___________________________________________________________ .

hereby authorize Robert A. vanNostrand, of RR#4 Shubenacadie, Nova Scotia (the photographer) and or parties designated by the photographer (including clients, purchasers, agencies and periodicals or any other printed matter and their editors) to use my photographic image in conjunction with my name (or the following fictitious name: ______________________ ), for sale to or reproduction in any medium the photographer or his designees see fit for purposes of advertising display, audio visual exhibition, or editorial use.

The above consideration is payable to the model within 10 business days of such time as the photographer has obtained a contract of sale or lease for the photographic image.

This release is related to the following photographic images (Digital image number), and subsequent images taken of me.

I affirm that I am more than 21 years of age.

__________________________________________ ___________________________________________

Signature Printed Name

Address: ________________________________________________________________________

________________________________________________________________________

__________________________________________ ___________________________________________

Date: Phone Number

__________________________________________ ___________________________________________

Witness: Signature Witness Printed Name

Please sign two copies of this legal document; Mail one copy to:

Rob vanNostrand, RR#4 Shubenacadie, Nova Scotia, B0N 2H0

(902) 452-6765