Hi, Sharon:



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Photo/Image Use

Release Form

I authorize the Association for Library Service to Children (ALSC), a division of the American Library Association (ALA), to use my photo, image, and name – or that of my child(ren), if applicable – in any official ALA/ALSC materials, both print and online, that promote reading, book awards, early literacy, libraries, library service to youth, ALA, and/or ALSC.

I understand that my photo/image [or that of my child(ren)] may be used in media reports associated with coverage of American Library Association/Association for Library Service to Children programs and events.

I understand that no payment is due me for such usage.

Name(s) (please print) ____________________________________________________

____________________________________________________________________

____________________________________________________________________

Signature_____________________________________________Date____________

If under 18 (please be sure to print child’s name in the space above)

Parent’s Name (please print) _______________________________________________

Parent’s Signature ______________________________________Date___________

Association for Library Service to Children | American Library Association

50 East Huron Street

Chicago, IL 60611

1-800-545-2433

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