100th Anniversary Photo Release Form
Scout’s Name: ____________________________________ (Please print)
Parent’s Name: ____________________________________ (Please print)
Unit #: ________________
Permission to Use Photograph
I grant to Bay Area Council, its representatives and employees the right to take or use
photographs of me and my property in connection with the above identified subject. I
authorize Bay Area Council, its assigns and transferees to copyright, use and publish the
same print and/or electronically.
I agree that the Bay Area Council may use such photographs of me with or without my
name and for any lawful purpose, including for example, such as publicity, illustration,
advertising and Web content.
I have read and understand the above:
Printed Name: ______________________________
Organization Name (if applicable): ______________________________
Address: ______________________________ City, State, Zip: ____________________
Phone: ________________________ Date: _________________________
Signature, parent or guardian (if under 18): ______________________________
Please return form, along with your photo to email@example.com or via mail
to: Bay Area Council, BSA, Attn: Tina Brendle, 3020 53rd Street, Galveston, TX
77551. Or you can fax the form to 409-744-7850.