Wisconsin Model Release Form 1
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Model Release Form
Wisconsin POA Club Web Page
I hereby give the Wisconsin Pony of Americas (WPOAC), Their legal representatives and delegates,
including those acting on behalf of the WPOAC, the right and permission to use and/or publish still
pictures, video and audio recording, textual description of me and/or the effects of WPOAC upon me in
conjunction with my own or fictitious name, made through any media, for use in advertising, publicity,
promotion or training.
I hereby warrant and represent that I am of full legal age and have every right to contract in my own name
in the above regard. (If model is a minor, parent or legal guardian must also sign.) I state further that I
have read this authorization, prior to its execution, and that I am fully familiar with and understand the
contents thereof.
Date ___/_____/______