Image Release Form

Image Release Form

In consideration of participation in the ________________________________ (organization’s name), the undersigned agrees that their likeness, or the likeness of their child/ward may be photographed or videotaped and that such image may be published in an outlet used to promote or publicize the sports program.

________________________________   ____________
(Parent/Guardian Signature)          Date

________________________________
(Print Name)

________________________________   ____________
(Parent/Guardian Signature)         Date

________________________________
(Print Name)

Names of children/wards:
____________________________________________________ ____________________________________________________ ____________________________________________________