Photo Release Consent Form

I understand that Pine Haven Photography (Boldt Pine Haven LLC), to increase future business, promotion of the event or performance, may take photos and/or video of program participants during program activities and events to use in educational or promotional materials in print, multimedia, or web form. Photos & videos will only be used for purposes related to these programs and partners.



Please select the correct box on the form as to whether or not you wish to grant Pine Haven Photography (BPH LLC) permission to use your (or your child's) photos/videos taken during a program, session or event. Additionally, please complete the information adjacent to this paragraph and sign this form in verification of your permission regarding BPH use of your (or your child's) photos/videos.