Summer Reading Registration
May 29 - July 31
First Name *
Your answer
Last Name *
Your answer
Parent's Name (First and Last) *
Your answer
Grade in Fall 2018 *
Your answer
Register for... *
Phone Number *
Your answer
Email *
Your answer
Photo Release
I hereby grant Henry Public Library permission to take, use, reuse, and publish: photographs and/or videos of me/my child in and and all of its publications and in any and all other media, including by not limited to use and publication on the Internet, web pages, and social media accounts, whether now known or hereafter existing, controlled by the Henry Public Library, in perpetuity and for other use by the Henry Public Library. I hereby release and discharge the Henry Public Library, its directors, employees, agents, representatives, licensees, and other related parties from any and all claims, demands, actions, causes of action, and costs of any nature arising from or related to the use, re-use, and publication of the aforesaid photographs and videos, including but not limited to claims for libel and invasion of privacy.
Please initial that you have read and understood the above policy.
Your answer
Please check one of the following choices.
If you prefer not to choose one of these options, please give a brief statement with concerns or objections.
I GRANT permission for photos/videos of my child/me to be published WITH first name and/or grade
I GRANT permission for photos/videos of my child/me to be published WITHOUT any personal identifiers
Photo release statement
Your answer
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