Photo Release
GIRL SCOUTS OF KENTUCKIANA PHOTO RELEASE AND CONSENT FORM
I understand the importance of using images and sound recordings of Girl Scout activities in printed materials, Girl Scout websites, videos, and television broadcasts. Therefore, I give permission for Girl Scouts of Kentuckiana, Girl Scouts of the USA, and their affiliates to use photographs, video recordings, and voice recordings of me and any children ages eighteen and under for whom I have legal guardianship. This consent includes the storage, retrieval, and reproduction of information or images. Photographs, videos, audio recordings and the tapes, negatives, and digital media from which images and sound recordings are made shall be the property of Girl Scouts, which shall have the right to publish, reproduce, distribute, and make other uses free of all claims on my part.
Printed Name of Adult: __________________________________
Signature of Adult: _____________________________________
Street Address: ________________________________________
City, State, Zip Code: ____________________________________
Phone Number: daytime (___) ________________ evening (___) ________________
Email Address: _________________________________________
Printed Names of Children: ________________________________
Ages of Children: _______________________________________
Troop # (if applicable): ___________________
Date: _____________________, 200__
Name of event (if for a specific event) _____________________________________
(This form can be used for any event and does not expire.)
Questions? Contact the marketing department at 502-636-0900 or 1-888-771-5170 (toll-free) or send us a message . Please note that photos placed on the council website will NOT have girl or adult names or other identifying information. We urge parents to visit www.kyanags.org before declining permission for website usage of photos. If you still do not want your or your child’s image to appear on the website, please check here. ___
If mailing, please return this form to:
Marketing Department
Girl Scouts of Kentuckiana
PO Box 32335
Louisville, KY 40232-2335