Media Release Form

As part of the Lansdowne Swim Club communication process, the club maintains a web site and periodically prints newsletters and events or provides information it’s members via social media. This form documents how you want your swimmer’s information handled.

Please Read and Sign Below. Indicate Yes or No where appropriate

Name

First Name

Last Name

Email

Phone

(###)

###

####

Pool Membership Number

I hereby grant permission to the Lansdowne Swim Club and their authorized agents, representatives or employees to use photographs or video taken of me or my child(ren) for use in swim club publications such as recruiting brochures, newsletters, magazines and use these photographs on display boards and to use such photographs in electronic versions of the same publications or on swim team web sites or other electronic form or media, and to offer them for use or distribution in other non-swim team publications, electronic or otherwise, without notifying me. I hereby waive any right to inspect or approve the finished photographs or printed or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the photograph.

Yes

No

Please type your full name to confirm