Photo & Video Release Form

Child's Name

If you are an adult swimmer/participant, skip this field.

First Name

Last Name

Parent/Guardian Name

If you are an adult swimmer/participant, skip this field.

First Name

Last Name

Adult Swimmer/Participant Name

If you are the parent of this child swimmer/participant, skip this field.

First Name

Last Name

Phone *

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I grant to Worden Aquatics, its representatives and employees the right to take photographs and/or shoot video of me and or my child in connection with the above - identified subject. I authorize Worden Aquatics, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Worden Aquatics may use such photographs or video of me and my child with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. *

I have read this release and understand what it says

By typing your name to agree to the terms of this Photo/Video Release Form *

First Name

Last Name

Date *

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DD

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