internet, webpages, and social media accounts, whether now known or hereafter
existing, controlled by ... Frank Sarris Public Library. Fredericktown Area Public ...
PHOTO RELEASE FORM Date: _____________
Libraries Avella Area Public Library Bentleyville Public Library Eva K. Bowlby Public Library Burgettstown Community Library California Area Public Library
I hereby grant WAGGIN Libraries permission to take, use, reuse, and publish: photographs and/or videos of me/my child in any and all of its publications and in any and all other media, including but not limited to use and publication on the internet, webpages, and social media accounts, whether now known or hereafter existing, controlled by WAGGIN Libraries, in perpetuity and for other use by WAGGIN Libraries. I hereby release and discharge WAGGIN Libraries, their directors, employees, agents, representatives, licensees, and other related parties from any and all claims, demands, actions, causes of action, and costs of any nature arising from or related to the use, re-use, and publication of the aforesaid photographs and videos, including but not limited to claims for libel and invasion of privacy.
Check one of the following choices:
o
I GRANT permission for photos/videos of me/my child and name may be published.
o
I GRANT permission for photos/videos of me/my child may be published without any personal identifiers.
Chartiers-Houston Community Library Citizens Library & District Center Donora Public Library Flenniken Public Library Frank Sarris Public Library Fredericktown Area Public Library Greene County Library System
Full Name* (print): ______________________________ Name of Parent/Guardian* (print):
Heritage Public Library Marianna Community Public Library Monongahela Area Library Peters Township Public Library
______________________________________________ Relation to subject: _____________________________ If subject is less than 18 years of age, parent signature required.
John K. Tener Library
Signature*: ____________________________________
Uniontown Public Library
Address: ______________________________________
Washington County Library System City, State, Zip Code: ____________________________ Please return this form to any WAGGIN Library.
Telephone: ____________________________________
Questions? 724-222-2400
[email protected]
Email: ________________________________________ *Required
