Photo Release - English

I give Assistance League of the Eastside permission to publish the photograph of the subject:

I agree to the consent to publish

YES

NO

Opt out of Name Publication (if you want your image used without your name associated with the photo): Select ... YES NO

Exact Participant Name for Publication:

Exact Name of Parent/Guardian (for subjects under 18 years of age):

Parent/Guardian Approval (if applicable): Select ... YES NO

Participant Email (for subjects over 18 years of age):

Date

Name of the ALE Member gathering media for publication:

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