Model Consent Form for Camps
I CONSENT to the use of my name and/or my likeness for the purpose of advertising or trade by the New York State Department of Environmental Conservation or anyone authorized by that Department to act on its behalf. "My likeness" includes photograph, videotape recording, film or artistic rendering of me, a recording of my voice, and/or reproductions of any of these. I agree that the actual material involved, such as a digital image photograph, negative, plate, video recording, film, or audio recording is and shall continue to be the property of the New York State Department of Environmental Conservation.
I understand and agree that I will not be compensated in any way for the use of my name and/or likeness by the New York State Department of Environmental Conservation. I also understand that the New York State Department of Environmental Conservation may incur expenses in connection with the recording or reproduction of my name and/or likeness, and that I am free from any responsibility for these expenses.
If more than one person signs this consent each such person hereby agrees to the preceding provisions.
If the person who is being photographed, filmed, videotaped or recorded is under age 18, his/her parent or guardian must also sign below.
CAMPER'S SIGNATURE_______________________________ DATE___________________
PARENT/GUARDIAN'S SIGNATURE_____________________________________________
ADDRESS___________________________________________________________
CAMP STAFF USE____________________________________________________________
