Summer Photography Camp Waver

Photography by Lloydlee Heite

Summer camp waver

Participant

First, M.I., Last Name _________________________________________ Age________ DOB ________

RELEASE STATEMENT: I understand that Photography by Lloydlee Heite provides no medical coverage for participants unless specified and that all

bills which may be incurred as a result of an activity-related injury are my responsibility. I hold harmless Photography by Lloydlee Heite and all other

parties involved in the conduction of these activities. I agree that any photographs taken during the event shall be free to be used to promote future events and photography activities.

Parent/Guardian Signature: ______________________________________ Date: ______________

Please return this waiver-release statement to your Photography by Lloydlee Heite.

PLEASE PRINT AND FILL OUT COMPLETELY

Parent/Guardian First Name: _____________________M.I.____ Last Name: ___________________________________

Address: _____________________________________________________ City: ____________ State: ____ Zip: _______

Phone: (home) _________________________ (work) ___________________________ (other) __________________

 

 

Photography By Lloydlee Heite

10277 Sunnyside Road

Bridgeville, De 19933

(302) 682 7000

E-mail