Youth/Student Photo Release

Youth/Student Photo Release

Rural Network Stock Photo Library
Background:

You are signing this form because a photo of your child/student was submit to the Rural Network online toolkit. We are unable to publish photos of minors without parent/guardian permission.

Purpose:

We are building a rural stock photo library to help coalitions and community organizations accurately represent rural lifestyle and culture in media.
Youth/Student Name *

First Name Last Name
Parent/Guardian Name *

First Name Last Name
I provide permission for photos of my child to be published in the Rural Network Online Toolkit by Prevent Coalition. Photos submitted may be used for promotion and reporting by Prevent Coalition and the Washington State Department of Health. *

Yes, I give permission.
Signature

Clear
For questions or concerns contact Prevent Coalition at preventcoalition@esd112.org or visit www.preventcoalition.org/rural.
Should be Empty: