Photo Release Form

2010 Envirothon

Turn In At Registration

All information must be completed in full for each team member and coach. Please type

 or print clearly. Form must be signed by parent if student is under 18, and must be turned

in at registration on April 13.

I hereby give the unqualified right to the Missouri Envirothon Committee to make pictures or videos of me (or of my minor child) ___________________________, and to put the finished pictures on the web page, in news articles, or any legitimate use without limitations or reservation.

Signature: __________________________________________

Name Printed: _______________________________________

Address: ___________________________________________

City: __________________ State: _________ Zip: __________