Picture Release Form

I hereby consent to the use (full or in part) of all videotapes and/or pictures taken of me by Camp Good News staff for use at Camp Good News.

Camper’s or Counselor’s Name __________________________________________________________

Address _______________________________________________ City _________________________

State _____________________ Zip Code ________________ Date _____/______/_____

Please complete if the subject is a minor under the laws of the state where modeling, acting or performing ­ camp activities is done:

Legal guardian (signature) __________________________________________________________________

Legal guardian (print) ______________________________________________________________________

Address ________________________________________________________________________________

City __________________________________________________________________________________

State ___________________ Zip Code ___________________ Date ______/______/_____

Please fax or mail to:

CAMP GOOD NEWS RETREAT CENTER
Administration Office
6205 Delany Road
Hitchcock, TX 77563

Office: 409-316-0501 Fax: 409-986-4219 
email: campgoodnews4u@yahoo.com 
web: www.campgoodnews4u.net