Virginia Discovery Museum

Photo Release Form

I give permission for the photographs of ____________________________

                                                            NAME OF SUBJECT, PLEASE PRINT

to be used by the Virginia Discovery Museum for promotional purposes (e.g.

news releases, public service announcements, brochures, information cards). 

_______________________________                  _______________________

NAME OF CONSENTER, PLEASE PRINT                               RELATION TO SUBJECT

_______________________________                _______________________

                                                                                         DATE

_______________________________              

                 FULL ADDRESS

_______________________________                _______________________

                   HOME PHONE                                        WORK/CELL PHONE

                                               ____________________________

                                                                  SIGNATURE

-------------------------------------Official Use Only-------------------------------------

To help us match pictures with release forms, please describe the scene you have photographed:

________________________________________________________________

Photographer:  ____________________________  Number of Photos:  _______

Catalog number(s):  ________________________________________________