9 - Media Release - English[1]

Circle of Friends

Media Release
Yes, I give Circle of Friends permissionNo, I do not give Circle of Friends permission
To use visual images, whether photographs or film, of my child in all media for the purpose of telling the story of Circle of Friends. In granting permission, I understand that the images may appear in a variety of forms, including but not limited to magazines, newspapers, books, brochures, newsletters, television, videotape, advertisements and the Internet.

I release Circle of Friends from any and all claims arising out of or in connection with the use of the photographs, including any and all claims for libel.
Child's Name

First NameLast Name
Address
Phone
Parent/Guardian Name

First NameLast Name
Parent/Guardian Signature

Clear
Mentor Name

First NameLast Name
Today's Date

MonthDayYear
Date
Should be Empty:

Circle of Friends