Lincoln-Adams 4-H Media Release

I give members, volunteers and agents of the Lincoln-Adams Area 4-H Program 
permission to publish or exhibit images or information about me related to involvement 
with 4-H, with or without my name. I understand that images published on 4-H WEB 
pages may only include first names.

Signature: ________________________________________ Date _________________

Signature of Parent or Guardian required if person above is 18 years old or younger.

Parent/Guardian Signature: _________________________________________________

Original signed release should be sent to WSU Cooperative Extension, 210 W Broadway, 
Ritzville, WA  99169
4-H member and or leader may request a copy for their records.