Black Cultural Centre Model Release Form Question Title Question Title * 1. Full Name (Required.) Question Title * 2. Email Address (Required.) Question Title * 3. Phone Number (Required.) Question Title * 4. Address Question Title * 5. Are you the owner of the photo? (if Uploading A Photo) Yes No Question Title * 6. Do you grant permission to use your photo for promotional purposes? (Required.) Yes No Question Title * 7. Do you understand that you will not receive any compensation for the use of your photo? (Required.) Yes No Question Title * 8. Do you agree to the terms and conditions of this model release form? (Required.) Yes No Question Title * 9. Are you over the age of 19? (Required.) Yes No Question Title * 10. Name of Parent or Guardian Next