Summer Camp Medical Release Form (Page 3 of 3) in pdf

Summer Camp Medical Release Form Page 3

EMAIL LIST (REQUIRED)

I would like the following email to be added to The Muse Knoxville Email List.

_____________________________________________________________________________________

Print Name

Signature

___________________________________

_____________________________________________

Date______________________________

PHOTO RELEASE (PLEASE SIGN ONE OR THE OTHER)

I hereby grant permission to The Muse Knoxville to use photographs of me and/or my

child(ren) under 18 years of age for publicity and promotional purposes.

Print Name

Signature

___________________________________

_____________________________________________

Date______________________________

Print Child’s Name

Date

___________________________________

___________________________

I do not want The Muse Knoxville to use photographs of me and/or my child publicity

and promotional purposes.

Print Name

Signature

___________________________________

_____________________________________________

Date______________________________

Summer Camp Medical Release Form Page 3