Boy Scouts of America

Troop 37

Elon, Virginia

Photo/Video Release Form

At scouting events, photographs may be taken of your child in action! Please sign the following release form to use your child’s likeness. It is our policy not to identify youth members by full name or address in any photographs, videos, web sites or publications.

I, being the parent/legal guardian of ______________________________________,

Hereby consent that Troop 37 and the Boy Scouts of America at their discretion may use his image or likeness. Furthermore, I hereby consent that such photographs, films, and electronic images shall be their sole property and may duplicate and reproduce the images as they may desire free and clear of any claim or liability on my part. This authorization shall remain in effect until revoked by me in writing.

Name of Minor: ________________________________ Unit: ____________________

Signature of Parent/Legal Guardian: __________________________________________

Street Address: ________________________________ Phone: ____________________

City / State / Zip: _________________________________________________________

Date: _____________________________

Return this form to:

Dennis Ratliff, Scoutmaster

144 Old Wright Shop Road

Madison Heights, VA 24572