Clone of Photo Release Form

Stillwater Public Library Photo & Video Shoot

Thank you for your interest in participating in our library photo and video shoot. We're celebrating the impact of our public library and would love to feature real patrons, volunteers, and donors using the library. Images may be used on our website, social media, and in promotional materials.
Photo/Video Appointment Details

Please check all the time slots you're available for on Tuesday, November 11, or Wednesday, November 12. Each shoot will take approximately 20 minutes. After compiling all responses, library staff will follow up to confirm a specific scheduled time.
Tuesday, November 11 (Select all that apply. Library is closed to the public for Veterans Day. If you select a time on this day, staff will meet you at the door and escort you in for your photo session.)

1-2 PM2-3 PM3-4 PM4-5 PM
Wednesday, November 12 (Select all that apply.)

9:30-10 AM10-11 AM11 AM-12 PM1-2 PM
Library Services Used By You/Your Family (Select all that apply.)

Books, Movies, Magazines, MusicAdult Programs (ex: Book Clubs, Art Classes, Nature Programs, Chess Club, Tech Help)Art GalleryMeeting SpaceReading SpaceStudy Rooms or WorkspacePublic Computers or PrintingStorytimesOther Kids Programs (ex: Art Classes, STEM Programs, Lego Club, Chess Club)Scavenger HuntDiscovery RoomLibrary of Things (ex: Telescope, Nature Backpack, Birding Kit, Virtual Reality Kit, Hotspot, Laptop)Digital Library (ex: Libby, Kanopy, Ancestry, LinkedIn Learning, BookFlix)
Any other information that would be helpful to know? Feel free to share your favorite programs, services, or materials.
Primary Contact Information
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Stillwater Public Library Photograph & Video Permission

Please complete the photograph release form below for all participating family members.
I give Stillwater Public Library and Stillwater Public Library Foundation and their assignees the absolute right and permission in perpetuity to use my photograph, video, portrait, likeness or voice or that of my minor child(ren) for whom I am a parent/guardian, names listed below, in its promotional materials and publicity efforts.

I understand that the photograph(s) or video(s) may be 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, the photographer, and the videographer from liability for any violation of any personal or proprietary right I may have in connection with such use.
Release of Adult Participants:
Adult Participant 1

First NameLast Name
Age Range of Adult Participant 1

18-2425-3435-4445-5455-6465 or over
Signature of Adult Participant 1

Clear
Adult Participant 2

First NameLast Name
Age Range of Adult Participant 2

18-2425-3435-4445-5465 or over
Signature of Adult Participant 2

Clear
Release of Minor Participants (under 18):
Names and Ages of Minor Participants
I permit the use of my first name and the first names of my minor child(ren) in Stillwater Public Library and Stillwater Public Library Foundation promotional efforts.*

YesNo
Parent/Guardian Signature

Clear
Date Release(s) Signed*

MonthDayYear
Date
Should be Empty:

Stillwater Public Library Photo & Video Shoot

Photo/Video Appointment Details

Primary Contact Information

Stillwater Public Library Photograph & Video Permission