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Costume Gallery - Model App

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Costume Gallery - Model App
4451 S. Route 130
Burlington, NJ 08016-2384
Phone 609-386-6601
Fax 609-386-3062
Print this form and attach 2 recent photos, one close up and the other in costume.
Mail to above address.

Name______________________________________ Birth date_______________________

Parent's Names__________________________________________________________________



Phone #_________________ Mom's Work #_________________Cell______________________

Do you wear braces on your teeth or plan to have them put on? ______ If so, when? __________

What dance school do you attend? ______________________ Location ____________________

How many years? _______Kind of dance you study ____________________________________

I grant permission for Costume Gallery to use my photos in whole, or in part, in its catalog,
advertising or internet ads, and/or websites for an undetermined period of time. By signing below
I acknowledge that any photographs taken by Costume Gallery becomes the sole property of that
company and may be shared with other dance related companies to be used in their advertising. If
I do appear in the catalog, I agree not to model for other dance costume companies for the year
the photos appear in the Costume Gallery book.

Model signature if over 18 years old ________________________________________________
Parent/Guardian if under 18 years old _______________________________________________

To be completed by Costume Gallery:
Measurement Date_______________________
Bust ___________
CG Size _____________ Comments:__________________

Waist __________
_____________ ____________________________

Hips ___________
_____________ ____________________________

Girth ___________
_____________ ____________________________

Inseam __________
______________ ____________________________

Height ___________ Shoe size _____________ ____________________________

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