Permission to Photograph and/or Videotape

Sellers Library * 76 S. State Rd. * Upper Darby, PA 19082* 610-789-4440

Sellers Library includes photographs and videos of library users and events in its print and online publications.
Please sign this release form to grant the library permission to use photos of you/your child.

I hereby give my unconditional permission to the Upper Darby Township and Sellers Memorial Free Public
Library (Sellers Library) to use photo or video images taken of me/my child and release them for the purposes
of promoting, publicizing, and advertising the library and its programs. I understand that images used in print or
online by Sellers Library do not identify specific people by name. I expressly release Sellers Library from any
claim for financial compensation both now and in the future.

Name(s)
and
Age(s)

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Address

______________________________________________________________________________

City/State/Zip ______________________________________________________________________________
Telephone

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Signature

______________________________________________________________

Date ________

Signature of Parent or Guardian _________________________________________________

(if under 18)

Date ________