Student Name *

First Name

Last Name

Parent/Guardian Name *

First Name

Last Name

Student Phone *

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Parent/Guardian Phone *

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I have shared information with my parents and have their permission to participate in the Domenica Michelle Senior Rep program. *

I am a graduating High School senior in the Class of 2022. *

I understand I must schedule my exclusive discounted Senior Session by May 1st, 2021 and complete it before August 30, 2021 in order to quality for the Senior Rep program. *

Our Senior Reps are loyal Domenica Michelle Photography clients- and aren't just seeking out a free session! Please note that you can only represent one Photography studio at a time and you are agreeing to only represent us.

LAST STEP! Please send up to three photos of yourself to domenicamichelle.photo@gmail.com or DM them to me on Instagram @domenica_photo *

I will email photos.

I will DM photos on Instagram.