MEDIANINE MODEL INFORMATION

Fictional/Stage Name:

PERSONAL DATA:

Height Weight Hair (length/color) Eye Color

Measurements:  

Bust Waist Hips

Wardrobe Sizes:

Bra Panty Pants
Dress Shoe Boot

The following answers are requested to help us provide a safe and comfortable working environment for everyone.

List/describe any piercings:

List/describe any tattoos:

Do you wear contact lenses?    Yes    No

Do you smoke?    Yes    No

List/describe any allergies (smoke, animals, food, latex, etc):

List/describe any health problems or physical limitations (back/neck problems, bad knees, recent surgeries, etc):

List/describe any phobias/fears: (claustrophobia, fear of clowns/bugs, squeamish etc):

 

CONTACT INFORMATION:

Name:
Phone Number:
Email:
Website:

   

LEGAL INFORMATION (The following information to be provided upon hire)

Your legal name will not be used in publication. Legal name, address, phone number and other personal information is confidential and will not be released to any persons or organizations not connected with MediaNine unless compelled to by a lawful authority.

Full Legal Name:
Mailing Address:
City/State/Zip
Date of Birth
Social Security Number
Drivers Licence/Photo
Identification Number   
State Issued

Agent or Person who referred you:

Model Comments: