Photo and Video Release Form

Photo and Video Release Form
Full Name*

First NameLast Name
Guardian Name (if child is under 18)
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Terms and Conditions
By completing this form, I give permission to the Markstay-Warren Public Library (MWPL) to use any photo, video or screen image taken of me and/or my children while visiting MWPL in person or online, or while participating in a MWPL event or program in person or online. I understand the photo/video/screen image may be used for Library publicity and/or reproduction purposes including social media.

I give this consent voluntarily, and understand that I can reach out to withdraw my consent at any time.
Date *

MonthDayYear
Math Captcha*
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Terms and Conditions