For good and valuable consideration, I hereby expressly grant all rights to THE AGILITY CLUB OF CENTRAL WYOMING, and assigns to photograph the following individuals:

________________________________________________________________________________________________________
Name of person(s) in photo

and/or to use their photo(s), or other reproductions of their physical likeness(es) as these appear in a still photograph(s), digital or electronic reproduction(s), or image(s), in connection with the use of these images for publication by THE AGILITY CLUB OF CENTRAL WYOMING, in print or electronically, now or at any time in the future.  I attest that the title and rights to this/these photograph(s), image(s), reproduction(s), and/or digital likeness(es) are mine to assign on behalf of myself and/ or

________________________________________________________________________________________________________
Name of Parent or Legal Guardian, if photo subjects are under the age of 18

I certify and represent that I have read the entire agreement, fully understand its meaning, and I agree to be legally bound by the agreement as

presented, this ____________________day of ______________________________________, 20_________.

Name (please print entire name)__________________________________________________________________________________________________

Signature____________________________________________________________________________________________________________________

Relationship to person(s) in photo________________________________________________________________________________________________

Address_____________________________________________________________________________________________________________________

City, State, ZIP_______________________________________________________________________________________________________________

Phone Number________________________________________________________________________________________________________________

Name of Photo________________________________________________________________________________________________________________

Caption or History behind Photo_________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

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Enclose a signed form with each photograph you submit for publication by THE AGILITY CLUB OF CENTRAL WYOMING.
MAIL TO: The Agility Club of Central Wyoming, PO Box 762, Evansville, Wyoming  82636
Information for this document has been gathered from the Dog Days of Denver Magazine