Appendix C

APPENDIX C

Consent to Photograph And Website Permission Form

From time to time, the Library may photograph you in connection with library activities. In addition, representatives from the local newspapers may attend events that are of interest to the general public. Your consent is necessary to allow your photograph in connection with these Library activities. You many withdraw your consent at any time.

I give/do not give (please circle one) my permission to have myself photographed when such photographs are in connection with Library activities in which I participate. I understand that I may withdraw consent at any time.

I give/do not give (please circle one) my permission to have posted, on the Morrisville Public Library’s website (www.midyork.org/morrisville), photographs of me when such photographs are in connection with programs in which I participate. I understand that only my first name will be used and that I may withdraw consent at any time.

Signature:_________________________ Date:______________

Please call the Library and speak with the Library Manager at 684-9130 if you have any questions regarding this form.

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