Free photo release form 30
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Photo Release Form for a Minor
(for participants under the age of 18)
I,

, am the parent or legal guardian of
(“my child”), a participant of the

Afterschool Program (“Program”), a program by New York City Department of Parks &
Recreation held at __________________________________Recreation Center
(“Recreation Center”), located in __________________________, New York.
I hereby consent to the publication and use of my child’s name and/or my child’s likeness
(“Likeness”) for the purpose of promotion, publicity, advertising, or other manner or media by
the City of New York (“City”), Parks or any other representative authorized to act on behalf of
the afore-mentioned entity. Likeness shall include, but not be limited to, photographs, sound
and/or video recordings, films, broadcasts, brochures, publications, reports, web pages,
promotional materials or any other audio-visual, electronic, printed, tangible work in any
media or format, now known or hereafter to become known, and/or reproduct