name *

First Name

Last Name

Phone *

Country

(###)

###

####

ARE YOU COMFORTABLE BEING FILMED OR INTERVIEWED ON CAMERA? *

YES

NO

WHAT'S YOUR AVAILABILITY LIKE FOR SHOOTS? *

WEEKDAYS

WEEKENDS

FLEXIBLE

OTHER

ARE YOU 18 OR OLDER? *

YES

NO

I CONSENT TO BE CONTACTED FOR MODELING OPPORTUNITIES BY ROOTS & RESILIENCE. *

Yes

No

agreement

I understand that by submitting this form, I am expressing interest in modeling for ROOTS & RESILIENCE. I agree that: • Any photos or videos captured during shoots may be used by Roots & Resilience for marketing, social media, website content, promotional materials, and other brand-related purposes. • I will not hold Roots & Resilience responsible for how my likeness is used in the context of brand representation. • Submitting this form does not guarantee selection, and all final model selections are made at the discretion of the brand team. • If selected, I may be asked to sign a separate model release or participation agreement before the shoot. I confirm that all information provided in this form is accurate and truthful to the best of my knowledge. • I have read and agree to the terms above. (Required to submit)

Yes