2011 Hudson River Estuary Program Snapshot Day
October 18, 2011
Use of Photography/Video - Permission Form
Your son/daughter will be participating in A Day in the Life of the Hudson River: Snapshot Day
2011 on October 18, 2011, a program hosted collaboratively by the New York State Department of
Environmental Conservation (DEC) Hudson River Estuary Program, Lamont-Doherty Earth
Observatory and the Hudson Basin River Watch (HBRW). We would like to use photographs
from this event on our websites (http://www.ldeo.columbia.edu/edu/k12/snapshotday/;
www.dec.ny.gov; www.hbrw.org/) and possibly in presentations, newsletters and other
publications. In order to use photographs of children, we need parent or legal guardian
permission.
Below is a permission form. Please sign and return it to your child’s teacher. If you have any
questions, please call Chris Bowser, DEC Science Education, Specialist at (845-264-5041). - - - - - - - - - - - - - - cut here - - - - - - - - - - - - - - - -
Model (Photo) Consent
I CONSENT to the use of my name and/or likeness for the purpose of advertising or trade by the
Day in the Life of the Hudson River: Snapshot Day event organizers (NYSDEC/HBRW) or
anyone authorized by them to act on their behalf. “My likeness” includes a 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 photograph,
negative plate, videotape recording, film or audio recording is and shall continue to be the
property of the organizing agencies. I understand and agree that I will not be compensated in any
way for the use of my name and/or likeness. I also understand that the New York State
Department of Environmental Conservation, LDEO and HBRW 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 the person who is being photographed, filmed, or videotaped or recorded is under age 18,
his/her parent or guardian must sign below instead.
Son/Daughter/Student Name. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Signed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date. . . . . . . . . . . . . . . . . . . . . . .
(Parent/Legal Guardian)
School Name. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
School Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Teacher’s Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Location of Snapshot Event . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Description: 2011 Hudson River Estuary Program – A Day in the Life of the Hudson River:
Snapshot Day