Jenzabar University

I (We),

give Dodge City Community College the unrestricted and discretionary right to:

(Check each box)

My signature on this form and checking the boxes indicate that I have read, understand, and agree to the aforementioned conditions, and release Dodge City Community College or its representatives from any and all claims.

Signature: 

Date: 

Email Address: 

Phone:  

Mailing Address: 

Upload Photo Here: 

(For persons under 18, fill out the second tab.)

For persons under the age of 18, the permission of a parent or guardian is required on this Photo Release Form.

I hereby grant permission to Dodge City Community College to use images of my child as outlined above.

Name of minor/child(ren): 

Name of minor/child(ren): 

Name of minor/child(ren): 

Name of minor/child(ren): 

Name of minor/child(ren): 

Name of minor/child(ren): 

My child(ren)'s name(s) MAY/MAY NOT be used in any of the aforementioned Dodge City Community College media forms.

Signature: 

Date: