Youth Connections Magazine Release Form

Youth Connections Magazine Photo/Information Release

I give my permission to The Legacy Center for Community Success to publish a photo(s) and/or biographical information of my minor child to use in their parenting magazine, Youth Connections. I understand that the photo(s) and/or biography will only be used for the purposes of the Faces in the Crowd and Assets in Action sections of Youth Connections magazine. The Youth Connections magazine is mailed to parents in Midland County, posted on The Legacy Center website, and is also distributed to organizations in the County.

Parent/Guardian's name *

First

Last

Child's name *

First

Last

Child's school *

Parent/Guardian's phone *

Child's grade level *

Parent/Guardian's email *

By checking the box below, I confirm that I am the parent/guardian of the minor child listed above. I confirm that I have read and agree to the conditions of The Legacy Center for Community Success' Youth Connections Magazine Photo/Information Release statement above. *

I agree

Today's date *