March Break Registration 2017


Student's Name 
Student's Email 

Date of Birth (mm/dd/yyyy)
Age

Select Your Program
Time
Day

Contact Information
Parent's Name 
Parent's Email 
Address
(Include Postal Code) 
Home Phone 
Other Phone 

Emergency Information
Please List Any
Allergies, Medications,
Special Health Needs.
Health Card Number

Emergency Contact
Emergency Number


How did you hear about us?



Photo Release (Ages 17 & Under)

I am the parent or guardian of the minor child named above and I have the legal authority to execute this release on behalf of the child.

For photographs and or mini video clips taken at GEMINI Modelling Agency during Programs 2016 - 2017.

I grant the photographer and GEMINI Modelling Agency permission to use the photos.

     1. For use on the geminimodels.com Website & Social Media
     2. In future promotional ads for GEMINI Models

I waive any right to review or approve the photographs or their specific use, so long as it falls under the above mentioned categories. I release, discharge, and agree to hold harmless the photographer and agent.


I have read and consent to the terms listed above.

I have read and do not consent to the terms listed above.










72 St Leger St #310
Kitchener, Ontario, N2H 6R4
Canada
Phone 519-578-2111
Fax 519-578-2226

March Break Registration 2017


Student's Name 
Student's Email 

Date of Birth (mm/dd/yyyy)
Age

Select Your Program
Time
Day

Contact Information
Parent's Name 
Parent's Email 
Address
(Include Postal Code) 
Home Phone 
Other Phone 

Emergency Information
Please List Any
Allergies, Medications,
Special Health Needs.
Health Card Number

Emergency Contact
Emergency Number


How did you hear about us?



Photo Release (Ages 17 & Under)

I am the parent or guardian of the minor child named above and I have the legal authority to execute this release on behalf of the child.

For photographs and or mini video clips taken at GEMINI Modelling Agency during Programs 2016 - 2017.

I grant the photographer and GEMINI Modelling Agency permission to use the photos.

     1. For use on the geminimodels.com Website & Social Media
     2. In future promotional ads for GEMINI Models

I waive any right to review or approve the photographs or their specific use, so long as it falls under the above mentioned categories. I release, discharge, and agree to hold harmless the photographer and agent.


I have read and consent to the terms listed above.

I have read and do not consent to the terms listed above.







Gemini Models
Email
 Model Booking
  mikela@gemimimodels.com
 General Inquiries
  info@geminimodels.com
Address
 72 St. Leger St., Suite 310
 Kitchener, Ontario
 Canada, N2H 6R4
Phone
 519 578 2111
Fax
 519 578 2226