Stillwater Public Library Photo & Video Release Form
Thank you for your interest in sharing your photos or videos with the library. We appreciate your willingness to allow us to use your photo(s)/video(s) on our website, social media and promotional materials.
Name of Adult
*
First Name
Last Name
Names of Minor Children
Photo Date
*
-
Month
-
Day
Year
Date photo(s) were taken
Photo Description & Comments
Please provide a brief description of photo(s) taken and available for use.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Image Permission: I give Stillwater Public Library and Stillwater Public Library Foundation the absolute right and permission to use my photograph, portrait or likeness or that of my minor child(ren) for whom I am a parent/guardian in its promotional materials and publicity efforts. I understand that the photograph(s) or video(s) maybe be used in a publication, print ad, direct mail piece, news release, electronic media (e.g. website, social media), or other forms of promotion or information. I release Stillwater Public Library and Stillwater Public Library Foundation, their agents, staff, and the photographer from liability for any violation of any personal or proprietary right I may have in connection with such use.
*
Yes
No
Name Permission: I permit the use of my first name or the first names of my minor child(ren) for whom I am a parent/guardian in Stillwater Public Library and Stillwater Public Library Foundation promotional efforts.
*
Yes
No
Adult Signature
Date Release(s) Signed
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: