Voices of the Ozarks Reservation

Voices of the Ozarks Reservation

Select which day works best for you, and we will get back to you.*Times/dates may change according to staff availability.
Name*

First NameLast Name
E-mail
example@example.com *Completing this field helps provide another point of contact.
Phone*
Please enter a valid phone number. This number will only be used for appointment confirmation by the library.
Location*
Date Selection for Iron County

MonthDayYear
DateHourMinutesAM/PM Option
Date Selection for Madison County

MonthDayYear
DateHourMinutesAM/PM Option
Please let us know any additional requests such as preferred time of day, the number of individuals accompanying, or special accommodations.
Release Form

The Library and the Participant agree as follows:

I grant the Library my permission and the right to film, record, and photograph me (the "Recording"). Further, I grant the Library and its affiliates, licensees, agents, and assigns ("Authorized Persons") the right to digitize, modify, alter, edit, adapt, display, publicly perform, exhibit, transmit, broadcast, reproduce, or otherwise use, and permit others to use my name, image, likeness, appearance, and voice as they appear in the Recording, in perpetuity and in any medium or format whatsoever now existing or hereafter created on any platform, without further consent from or any royalty, payment, or other compensation to me.
Signature*

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For individuals under the age of 18, the permission of a parent or guardian is required on this Media Release Form. I hereby grant permission to Ozark Regional Library System to use the photograph and/or video of my child as outlined above.
For individuals under the age of 18, how would you like them to be identified?

Permission given to identify by first and last namePlease identify by first name onlyPlease do not identify by name
Signature of parent/guardian of individual(s) under the age of 18

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