Art Therapy Sessions

Model Name Address Phone Email

Art Therapist/Facilitator Name Session Date(s) Session Location

Permissions

Description of Artwork/Media I, the undersigned, hereby grant permission for the use of my artwork, likeness, and/or photographic images created during the art therapy sessions for the following (check all that apply):

Exhibitions

Publications

Research/Education

Website/Social Media

Any limitations or conditions:

I understand that my name and personal information will remain confidential unless I provide separate written consent. I acknowledge I have the right to revoke permission in writing at any time.

Model Signature

Date

Therapist/Facilitator Signature

Date

If model is under 18, parent/guardian consent:

Signature of Parent/Guardian

Date

Art Model Release Form

Art Therapy Sessions

Permissions