Business Name Business Address - City, State Zip Business Phone - Business Fax E-mail: - Website: Date PHOTO RELEASE FORM Subject's name: ____________________ We, ___(insert names of parents/guardians)___ of __(insert name of minor) __, hereby give __Business Name__ and their legal representatives and assigns, the right and permission to publish, without charge, photographs taken on (Month/Date/Year) _______________ at (Locations or Events) _____________________________________ ________________________________________________________ ________________________________________________________. These photographs may be used in publications, including electronic publications, or in audiovisual presentations, promotional literature, advertising, or in other similar ways. CIRCLE ONE: Professional Name of Subjects MAY/MAY NOT be given. ..........................(insert professional name) We hereby warrant that we are over eighteen (18) years of age, and are competent to contract in our own names. Signature(s): ________________________________________ ................... ________________________________________ Names of Above (please print): _________________________ Month/Date/Year: _________________________________ Address: _________________________________________ City: __________________________ State/Zip Code: _______ Primary contact can be contacted at (circle one): work home Telephone: _________________________________________ (optional) E-mail: ____________________________________ Photographer: _______________________________________ Disclaimer: Above information is held in confidence and is never released or sold.

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Friday, August 10, 2007