Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Student's Phone *

(###)

###

####

BIRTHDATE *

MM

DD

YYYY

Parent or Guardian Name

First Name

Last Name

I certify that I am currently a Senior at the school named above and will graduate with the class of 2025.

Agree

I understand that if selected to be a Senior Rep, I will be held to the Terms and Conditions as outlined in the Senior Representative Contract.

Agree

I understand that if selected for the program, my images will be used in the Photographer's promotional and marketing materials, social media, website, and displays.

Agree

I understand that in return for their service, Senior Reps receive a FREE Lifestyle Senior Portrait session plus the chance to earn free prints, digital files, and products.

Agree