Library Newsletter Photo Consent Form
Grant permission for the use of photographs in our library newsletter. Please complete the form to provide your consent.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to the Library
*
Please Select
Patron
Staff Member
Volunteer
Event Participant
Other
Are you providing consent for yourself or as a parent/guardian for a minor?
*
Myself (I am 18 or older)
As parent/guardian for a minor
If providing consent as a parent/guardian, please enter the minor's full name
Event or context where the photo was taken (e.g., Summer Reading Program, Library Workshop)
*
Date of Photo or Event
-
Month
-
Day
Year
Date
Please upload a photo of yourself (optional, for identification)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Please indicate any restrictions or preferences regarding the use of your photo (optional)
Signature
*
Date of Consent
*
-
Month
-
Day
Year
Date
Submit Consent
Submit Consent
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