Photo Release Form
Date: __________________________________________________________
I hereby give permission to Custer Lego League, its committee and adult leaders to use
images/photographs/videos whether a hard copy or electronic files of the persons listed below to
be published on the Facebook Page Custer Lego League, in the newspaper or in other
publications and/or promotional material. I understand that these images/photographs/videos
can be viewed by anyone Associated with the Facebook Page. Custer Lego League will not list
the team members full name in any of its own publications. I also understand that this
permission can be revoked with a written note to Custer Lego League.
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: ____________________________________________________
Child's name: ____________________________________________________
Adult's name (print): ______________________________________________
Adult's signature:
______________________________________________
I do not give permission for Custer Lego League to publish any images on their website.
Adult's name (print): ______________________________________________
Adult's signature:
______________________________________________
Child's name: ____________________________________________________