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Photo Session/ Model Release Order Form

This form may be copy/pasted

 Rakkasah East Festival

Your photo(s) may appear at the official Event website for this performance, therefore a signed Model Release is required. I hereby give the photographer, his legal representatives and/or those assigned, those for whom the photographer is acting, and those acting with his permission, or his employees, the right and permission to copyright and/or use, reuse and/or broadcast and republish photographs of me, or in which I may be distorted in character, or form, in conjunction with my own or fictitious name (AKA also known as), on reproductions thereof in color, or black and white made through any media by the photographer at his studio or elsewhere, for any purpose whatsoever, including the use of any printed matter or publication at a website in conjunction herewith.

__________________________________________  _________________________________

Model Release Signature (troupe signatures on back) Date

(Your signature and contact information below on this photo release is not a commitment to purchase photos.)

Program listed Dance Name/AKA


Name of Troupe


Mail to Name


Mailing Address





Email _______________________________________

Your Performance Photo CD Order includes 15 to 30 (or more) high resolution photos, personalized CD label, and the photographer’s photo usage authorization release mailed in approximately four weeks. You may reproduce, print, or upload photos to websites with photo credit to Carl Sermon. Website link to

www.ReelSoundandLight.com appreciated for photos published at websites. Photos taken are retained, stored, archived, and on file with Carl Sermon, Reel Sound and Light Productions. For special orders and previous performances, contact Carl Sermon at Reel.Sound@comcast.net or (408) 356-9473. Photo Sessions 30 minutes (2 sessions may be booked back-to-back)

  • I wish to order my Performance (or troupe) photos on a Photo CD. ($40) per performance

Prepayment – call with credit card (408) 356-9473





Performance (1)




Performance (2)











Total Amount


Reel Sound and Light Productions, 15651 Camino Del Cerro, Los Gatos, CA USA 95032-3721 or as an email atachment to Reel.Sound@comcast.net,

Return this signed order form and check payable to:

 Carl Sermon Photography

Reel Sound and Light Productions

15651 Camino Del Cerro, Los Gatos, CA USA 95032-3721 Tel (408) 356-9473

 Call (408) 356-9473 with credit card info.

VISA/MC #_________-_________-__________-_________

Expiration Date: __________

 3 digit code on back of card: ___________