Photo Release Form

Event:   __________________________________________________________ 

Date:    __________________________________________________________

I give permission for photographs of the persons listed below to be published on the website of Make A Memory.

I understand that these photos can be viewed by anyone in the world, but no identifying information will be displayed.

I am over 18, and I give permission for my image to be published.

Print name:       ____________________________________________________

Signature:         ____________________________________________________

I am the parent or legal guardian of the following child(ren) under 18 years of age, and I give permission for their images to be published.

Child's name:    ____________________________________________________

Child's name:    ____________________________________________________

Adult's name (print):      ______________________________________________

Adult's signature:           ______________________________________________

Please print and complete this form then fax to 302-368-4525

or mail to:

Make A Memory

Attn: JoAnne Hewlett

11 Virginia Place

Newark, DE 19711

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