Internet_release

                                                                            INTERNET RELEASE FORM

Parental/Guardian Consent Form

We are sending you this parental consent form to both inform you and to request permission for your child's
photo/image and personally identifiable information to be published on the association's web site.

As you are aware, there are potential dangers associated with the posting of personally identifiable information on a web
site since global access to the Internet does not allow us to control who may access such information. These dangers
have always existed; however, we as an organization do want to celebrate your child’s achievements. The law requires
that we ask for your permission to use information about your child.

Pursuant to law, we will not release any personally identifiable information without prior written consent from you as
parent or guardian. Personally identifiable information includes names, photo or image, residential addresses, e mail
address, phone numbers and locations and times of any trips.

If you, as the parent or guardian, wish to rescind this agreement, you may do so at any time in writing by sending a letter
to the executive board and such rescission will take effect upon receipt by the board.

Check one of the following choices:

       I/We GRANT permission for a photo/image that includes this Youth Angler without any other
      personal identifiers to be published on the HRFA’s public Internet site.

       I/We GRANT permission for this Youth Angler's photo/image and name to be published on the HRFA's public
      Internet site.

         I/We GRANT permission for this Youth Angler's photo/image and all other personal identifiers listed above to
       be published on the HRFA's public Internet site.

        I/We DO NOT GRANT permission for any photo/image that includes this Youth Angler to be published on
       the HRFA's public Internet site.

Youth Angler's Name: (please print)_________________________________Age:__________

Print name of Parent/Guardian: (print) __________________________________________________

Signature of Parent/Guardian: (sign) ____________________________________________________

Relation to Youth Angler: _______________________________________________________________

Date: ________________