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Get St. Marks National Wildlife Refuge Parent Release Form for Media Recording 2007-2024

Parent Release Form for Media Recording I the undersigned do hereby grant or deny permission to St. Marks National Wildlife Refuge SMNWR to use the image of my child as marked by my selection s below. Such use includes the display distribution publication transmission or otherwise use of photographs images and/or video taken of my child for use in materials that include but may not be limited to printed materials such as brochures and newsletters videos and digital images such as those on the St* Marks National Wildlife Refuge and St* Marks Refuge Association SMRA Web site. Deny permission to use my child s image at all* Grant permission to use my child s image in the following ways mark all that apply Limited usage I want my child s image used on printed materials only no digital or video use. Unrestricted usage I give unrestricted permission for my child s image to be used in print video and digital media* I agree that these images may be used by the SMNWR and SMRA for a variety of purposes and that these images may be used without further notifying me. I do understand that the child s last name will not be used in conjunction with any video or digital images. Parent/guardian signature Date Name of school your child attends. Date of field trip or program* Please make a copy of this form for your own records and mail or fax the original to Lori Nicholson Environmental Education Specialist St* Marks National Wildlife Refuge and St* Marks Refuge Association P. O. Box 68 St* Marks FL 32355 Fax 850-925-6930 If you have questions contact Lori at 850-925-6121. Nov* 14 2007. Such use includes the display distribution publication transmission or otherwise use of photographs images and/or video taken of my child for use in materials that include but may not be limited to printed materials such as brochures and newsletters videos and digital images such as those on the St* Marks National Wildlife Refuge and St* Marks Refuge Association SMRA Web site. Deny permission to use my child s image at all* Grant permission to use my child s image in the following ways mark all that apply Limited usage I want my child s image used on printed materials only no digital or video use. Deny permission to use my child s image at all* Grant permission to use my child s image in the following ways mark all that apply Limited usage I want my child s image used on printed materials only no digital or video use. Unrestricted usage I give unrestricted permission for my child s image to be used in print video and digital media* I agree that these images may be used by the SMNWR and SMRA for a variety of purposes and that these images may be used without further notifying me. Unrestricted usage I give unrestricted permission for my child s image to be used in print video and digital media* I agree that these images may be used by the SMNWR and SMRA for a variety of purposes and that these images may be used without further notifying me. I do understand that the child s last name will not be used in conjunction with any video or digital images. .

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