Date: __________________                                                                        Image description or #________________

I hereby represent and warrant that I am at least 18 years old and have the right and ability to consent in my own name.

I understand that California State Parks wants to take photographs of me and use and reuse these photographs as California State Parks deems appropriate.  Accordingly, I hereby grant to California State Parks the unrestricted right to copyright in the name of the California State Parks these photographs and use and reuse them, in whole or in part, in any manner, for any purpose and in any medium now known or hereinafter invented.  This right includes, but is not limited to, the right to publish, copy, distribute, alter and publicly display these photographs for editorial, trade or advertising purposes.

I understand that I will not receive any money for any use described above and I hereby waive any financial claim or rights pursuant to any such use.  I further waive any right to inspect or approve of the exact nature and use of the photographs, provided the photographs are used for the purposes described above.  I will receive one copy of one photograph of me, chosen by California State Parks in its sole discretion.

I release and discharge California State Parks from any and all claims and demands arising out of or in connection with any use of the photographs described above, including any and all claims for libel, defamation and invasion of privacy and/or publicity, and from any and all claims and demands arising by virtue of any blurring, distortion, alteration, optical illusion or digital enhancement, whether intentional or otherwise, that may occur or be produced in the publication of the photographs. 

 I realize I cannot withdraw my consent after I sign this form, and I realize this form is binding on me and my heirs, legal representatives and assigns.

Name:_______________________            Signature:__________________________
 (Please Print)


Telephone Number:__________________

I am the parent or legal guardian of the individual named above (if he or she is under the age of eighteen). and I hereby sign this consent form on behalf of such individual in accordance with the statements above.

Name:_______________________            Signature:__________________________


Telephone Number:__________________