GSA Network Photo Release Form (Under 18)


Program:  

Dates:  

Parent/Guardian: ,  

By selecting yes, you hereby authorize GSA Network to reproduce your image, photograph or to be filmed, as part of   , for publicity and fundraising purposes. Their photograph, image, or likeness may appear in either official materials including (but not limited to) brochures, websites, email blasts, or any other form of media and/or technology currently in existence or not yet developed. I understand that my/my child’s pictures and/or interview may be accessible to anyone with Internet access and may appear in local, statewide, national, and international print or television media.

Leave this empty:

Signature arrow
Signature Certificate
Document name: GSA Network Photo Release Form (Under 18)
lock iconUnique Document ID: 1ad58e937cb79c0b76c5128c6bfcdb79efc616c2
Timestamp Audit
July 15, 2020 3:13 pm GMTGSA Network Photo Release Form (Under 18) Uploaded by Anna Davis - adavis@gsanetwork.org IP 2601:c7:4200:7080:100d:b245:3103:5db5