Photo Release Form

Adult Model (19+)

Full Name

Contact (phone or email)

Child Model (under 19 years old)

Full Name of Child

Full Name of Parent/Guardian

Parent/Guardian Contact (phone or email)

I hereby give my permission to Coquitlam Public Library to use my/my child's photograph/image/audio recording.

These images/recordings may be used in any of the Library's promotional materials, and may be published at any time in the future in print, electronic or audio-visual format, such as the newspaper, the Library's website and/or social media accounts.

The Library and the photographer will not use the photographs or reproductions for any other purposes, or assign rights to do so to any other person.

I consent to Coquitlam Public Library publishing my/my child's photo and name in its digital and print publications.

Yes

Witnessed by Staff (enter staff initials)

For Staff Use Only