The Lebanon Lantern The Lebanon Lantern Spring 2019 | Page 16

PHOTOGRAPHY RELEASE FOR MINOR CHILD OR CHILDREN
I hereby authorize the Borough of Lebanon hereafter referred to as "Company," to publish photographs taken of myself and/or the minor
child or children listed below, and our names and likenesses, for use in the Borough of Lebanon print, online and video-based marketing
materials, as well as other Company publications.
I hereby release and hold harmless the Borough of Lebanon from any reasonable expectation of privacy or confidentiality for myself and
for the minor child and children listed below associated with the images specified above. Further, I attest that I am the parent or legal
guardian of the child or children listed below and that I have full authority to consent and authorize Borough of Lebanon to use their
likenesses and names.
I further acknowledge that participation is voluntary and that neither I, the minor child, or minor children will receive financial compensation of
any type associated with the taking or publication of these photographs or participation in company marketing materials or other Company
publications. I acknowledge and agree that publication of said photos confers no rights of ownership or royalties whatsoever.
I hereby release the Borough of Lebanon its contractors, its employees and any third parties involved in the creation or publication of Company
publications, from liability for any claims by me or any third party in connection with my participation or the participation of the minor children
listed below.
Authorization:
Printed Name: ______________________________
Signature: ________________________________________ Date: ________________________
Street Address: _____________________________________________________________
City: ______________________________________ State: __________ Zip: ____________________
Relationship to Children: _____________________________________________________
Names and Ages of Minor Children:
Name: __________________________________________ Age: _____
Name: _____________________________________ Age: ____
Name: _____________________________________ Age: ____
Name: _____________________________________ Age: ____