Date:
SECTION 1 – Subject Consent and Release (complete if providing consent by an individual appearing in photo)
Name:
Address:
City:	State:	Zip:
E-mail:	Phone:
I, the undersigned, do hereby release all rights or claims in connection with the photo(s)/video(s) in which I appear, for use by the Virginia Department of Forestry. I understand that the photo(s)/video(s), may be used for the promotional and educational purposes of the Virginia Department of Forestry. I agree to the use of my name, likeness, photo and voice for educational, program publicity, website and organizational promotional purposes. I waive any right to inspect or approve the finished copy. I agree that the photo(s)/video(s) may be broadcast and distributed without limitation through any means and I shall not receive any compensation for my participation. I further release the Department of Forestry, its employees and agents from all liability which may arise from any or all claims by me or any third party in connection with my participation in the photo(s)/video(s). All photos and videos shall constitute the sole property of Virginia Department of Forestry. I declare that I am of legal age and have every right to contract in my own name in the above regard.
Name (Print)	Signature	Date
If minor children are photographed or videoed, I declare that I am the legal guardian of these minor children and permit the use of these photo(s)/video(s) with the minor children by the Virginia Department of Forestry in accordance with the consent and release agreement stated above.
Child Name (Print)	Child Name (Print)
Guardian Name (Print)	Guardian Signature	Date
SECTION 2 – Photographer Consent and Release (complete if providing consent by a photographer)
Name:
Address:
City:	State:	Zip:
E-mail:	Phone:
I, the undersigned, do verify that I am the photographer of the material provided and release all rights or claims in connection with the photo(s)/video(s) for use by the Virginia Department of Forestry. I understand that the photo(s)/video(s), may be used for the promotional and educational purposes of the Virginia Department of Forestry. I agree to the use of my name as photographer and my photo(s)/video(s) for educational, program publicity, website and organizational promotional purposes. I waive any right to inspect or approve the finished copy. I agree that the photo(s)/video(s) may be broadcast and distributed without limitation through any means and I shall not receive any compensation. I further release the Department of Forestry, its employees and agents from all liability which may arise from any or all claims by me or any third party in connection with my photo(s)/video(s). I declare that I am of legal age and have every right to contract in my own name in the above regard.
Photo(s)/Video(s) Description:
Photographer Name (Print)	Photographer Signature	Date