Hi, Sharon:
[pic]
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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