I, the undersigned, do hereby grant permission to Benton County Public Library to use the image of my child/family member, ___________________.  Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of my child for use in materials that include, but may not be limited to, printed materials such as newspaper articles, brochures, newsletters, videos, and digital images for a website.

Parent/guardian Name printed_______________________________

Parent/guardian signature __________________________________  
Date _______________________

If you have any questions, contact Rhonda Tippitt, Library Director, at 584-4772