WILMINGTON RECREATION CLUB

PHOTO RELEASE AND CONSENT FORM

I, ______________________________________________________, acknowledge that from time to time, the Wilmington Recreation Club and/or its employees or designees may take photographs of my child participating in activities for use and publication in various publications or media, including but not limited to the Wilmington Recreation Club's website, social media, and Wilmington Recreation Club informational, promotional, or marketing materials, and I hereby expressly grant to the Wilmington Recreation Club the right to use and publish such photographs as contemplated herein, all without compensation or payment for such use and publication.

Child's Name Printed: ________________________________________________________

Parent/Guardian Name Printed: ______________________________________________

Parent/Guardian Signature: __________________________________________________

Date: ________________________________________________________________________

Phone #: _____________________________________________________________________

Membership ID #: ____________________________________________________________

This form must be completely filled out and submitted to Club Manager, Brad Southall prior to photos being published.