Organization Name
Address
City, Prov, Postal_code
Permission to Use Photograph
Subject: ____________________
Location: ___________________
I grant to [insert organization], its representatives and employees the right to take photographs of me and my property in connection with the above-identified subject. I authorize [insert organization], its assigns and transferees to copyright, use and publish the same in print and/or electronically.
I agree that [insert organization] may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.
I have read and understand the above:
Signature _________________________________
Printed name ______________________________
Organization Name (if applicable) __________________________
Address __________________________________
Date _____________________________________
Signature, parent or guardian _______________________(if under age 18)
