Wisdom Trail Media Release Form

The Media Release Form is required for all photographs of Scouts published/posted in a public media; for example, newspaper, flyer, website.

 
I hereby assign and grant the Boy Scouts of America, Circle Ten Council, and Pack ____ of __________________, Texas, the right and permission to use and publish the photographs/film/video tape/electronic representation and/ or sound recordings made of the below listed person(s). This release will be in effect from the date of signature until it is revoked by the parent or guardian. I hereby release, and hold harmless, all parties (Boy Scouts of America, Circle Ten Council, and Pack ____, including the charter organization) from and all liability for 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, Circle ten Council, and Pack ____, including the chartering organization, and I specifically waive and right to any compensation I may have for any of the foregoing.

Scout Name:________________________________________________________________________

Den # & Leader:_____________________________________________________________________

Parent Name:________________________________________________________________________

Address:____________________________________________________________________________

____________________________________________________________________________

Home Phone:________________________________________________________________________

Email Address:_______________________________________________________________________

I agree to the above and authorize the use of photographic images for myself and/or my child.

Signature of Parent/Guardian and Date:

___________________________________________________________________________________

I do not agree to the above. I do not authorize the use of photographic images for myself and/or my child.

Signature of Parent/Guardian and Date:

___________________________________________________________________________________