PUBLIC RELATIONS

RELEASE FORM (Website)

*I hereby assign and grant to the Boy Scouts of America, Northern Lights Council, Grand Forks AFB First Sergeant’s Council (Chartered Organization), and Troop 319 the right and permission to use and publish the photographs/film/video tapes/electronic representations and/or sound recordings made of ______________________________ (Scout’s Name, Print First and Last) for the remainder of the charter to Troop 319 and hereby release all parties (Boy Scouts of America, Northern Lights Council, Grand Forks AFB First Sergeant’s Council, and Troop 319) from any and all liability from such use and publication.

 I hereby authorize the reproduction, sale, copyright, exhibit, broadcast, electronic storage, and/or distribution of said photographs/film/video tapes/electronic representation and/or sound recordings without limitation at the discretion of the Boy Scouts of America, Northern Lights Council, Grand Forks AFB First Sergeant’s Council, Troop 319, and I specifically waive any right to any compensation I may have for any of the foregoing.

Scout’s Printed Name (Last, First):  __________________________________________

Mailing Address:  ________________________________________________________

Physical Address:  ________________________________________________________

Home Phone #:  __________________________________________________________

Home E-mail:  ___________________________________________________________

Sponsor’s Duty Phone #:  __________________________________________________

Parent/Guardian’s Printed Name (Last, First):  __________________________________

Parent/Guardian’s Signature & Date:  _________________________________________

Witness Printed Name (Last, First):  __________________________________________

Witness Signature & Date:  _________________________________________________

* I refers to the Parent/Guardian of the Scout Chartered to Troop 319.

None of the above information will be released to any agency outside Troop 319 and is only for the reference of Troop 319 Public Relations.