Heritage Life Story Funeral Homes “Grand Rapids Life Calendar”

2017 Calendar Contest

Date: December 9, 2016 I hereby consent to and authorize the use and reproduction, in print or electronic format by Heritage Life Story Funeral Homes or anyone authorized by Heritage Life Story Funeral Homes, of any and all photographs selected for the Heritage Life Story Funeral Homes “Grand Rapids Life Calendar” 2017 Calendar Contest. The selected photos can / may be used for the promotion of the current and subsequent calendars, or any publicity purpose without further compensation beyond the initial prize for the selected photo(s).

I hereby acknowledge that I am 18 years of age or older and have read and understood the terms of this release. Name: ________________________________________ Signature: ________________________________________ Email: ________________________________________ Phone: ________________________________________ Address: ________________________________________ ________________________________________ Complete ONLY if photographer is a minor I hereby acknowledge that I am under 18 years of age and have the consent of the parent / guardian who has read and understands the terms of this release. Name of Minor: ________________________________________ Name of Parent / Guardian ________________________________________ Signature of Parent / Guardian: ________________________________________ Phone: ________________________________________ Email: ________________________________________ Address: ________________________________________ ________________________________________