Free model release form 41
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PSNWA/Arkansas Department of Parks and Tourism

MODEL RELEASE FORM
(for parent or guardian)

I,____________________________________________________________, parent/guardian of
______________________________________________
do hereby authorize the Arkansas Department of Parks and Tourism, or any
agent it so designates, the uncontrolled use of any and all photographs, negatives, video and film
footage of my child, his/her voice or any electronic recording
of him/her, for the purpose of promotion and/or advertising in print media, electronic media and
over the Internet on behalf of the State of Arkansas.
NAME (please print): __________________________________________
SIGNATURE: ________________________________________________
ADDRESS:___________________________________________________
__________________________________________________
DATE: ______________________________________________________________________
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