Wufoo

Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
facebook handle / address *
High School *

Please Choose your School
I'm a member of the Class of: *
2013 2014 2015 2016
Please list 3 Jr Class friends for referemces (do not have to be from your school).
References may be checked.

If you are currently a Sophomore or Freshman please list references that are in your grade or below.

Jr Friends References #1 First Last
Email
Cell Phone Number ### - ### - ####
High School

Please Choose your School
My friend is in the Class of:
2013 2014 2015 2016
Jr Friends Reference #2 First Last
Email
Cell Phone Number ### - ### - ####
High School

Please Choose your School
My friend is in the Class of:
2013 2014 2015 2016
Jr Friends Reference #3 First Last
Email
Cell Phone Number ### - ### - ####
High School

Please Choose your School
My friend is in the Class of:
2013 2014 2015 2016
Job Experience:

If you work please let us know where and the dates of employment.
School Activities:

What school activities are you involved with? (sports, band, civic clubs, etc)
Tell us why you think you would be a good candidate for the Keith Seniors model program.
If this application leads to acceptance into the Keith Seniors model program, I agree to only represent Keith Photography and I will not model for or represent other photographers / studios.

I also realize that, if accepted, I'll pay a $50 reservation fee to reserve my model sessions. That entire amount will go toward my purchase.

(online applicants, please just initial and date the field below) *
I have my parent's permission.
(they may be required to attend the initial model meeting and or your sessions) *
Yes No
Do Not Fill This Out