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Please fill out your information & sign the photo/written releases

Dear mama, 
Thank you for taking the time out of your busy day to fill out this info sheet as well as sign the photo release so I have permission to use your name and photograph. I'm beyond grateful that you are taking part in this passion project! By sharing our stories I truly believe we are supporting each other in a wonderful and tangible way.
-Krysta

Name *
Name
Name as you would like it to appear in the book
Name as you would like it to appear in the book
Date *
Date
Phone *
Phone
Home Address *
Home Address
Photo Release *
I hereby authorize Krysta Shore to publish photographs of me, and my name, for use in print and online materials, including, but not limited to, Facebook, Instagram, blogs, and websites. I further acknowledge that my participation is voluntary and that I will not receive financial compensation associated with the taking or publication of these photographs. I acknowledge and agree that publication of said photos confers no rights of ownership or royalties.
Written Release *
I hereby authorize Krysta Shore to publish my written accounts, and my name, for use in print and online materials, including, but not limited to, Facebook, Instagram, blogs, and websites. I further acknowledge that my participation is voluntary and that I will not receive financial compensation associated with the publication of these written accounts. I acknowledge and agree that publication of said written accounts confers no rights of ownership or royalties.