Photo Release for Children Under 18 Years of Age
If you have won the Maryland County competition and will be advancing to the state competition, please fill out the following form for each student participant.
Mail completed forms to:
Ty Stinson
Maryland Department of the Environment
Montgomery Park Business Center
1800 Washington Boulevard, Suite 430
Baltimore MD 21230 - 1708
Photo Release For Person Under 18 Years Of Age
I hereby grant to the Maryland Envirothon and to its employees, agents, assigns, and sponsors (Maryland Association of Soil Conservation Districts, Maryland Department of the Environment, Maryland Department of Natural Resources, and US Department of Agriculture) the right to photograph my dependent and use the photo and or other digital reproduction of him/her or other reproduction of his/her physical likeness for publication processes, whether electronic, print, digital or electronic publishing via the Internet.
Model's Signature: _________________________________________________________
Model's Printed Name: _______________________________________________________
Address: _________________________________________________________________
_________________________________________________________________________
I certify that I am a custodial parent and have the aforementioned rights to assign.
Signature of
Parent or Guardian: _________________________________________________________Address: ________________________________________________________________
________________________________________________________________________
Date: __________________________
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