Submit a Photo

2. First Name*
3. Last Name
5. Preferred Contact Method*

   Please select your preferred contact method so that we can reach you if needed.

   1. Phone
   2. Email
7. Contact Information - Phone Number*
9. Contact Information - Email*
11. Event*

    Where were you and what was the event where you took this photo?

13. Upload a Photo*

    Please upload the photo which you would like us to review.

15. Upload a Photo

    Please upload the photo which you would like us to review.

17. Upload a Photo

    Please upload the photo which you would like us to review.

19. Photo Release
21. I hereby grant Village of Waunakee permission to use my or my child's likeness in a photograph in any and all of its publications, including website entries, without payment or any other consideration.*

    1. Agree
23. I understand and agree that these materials will become the property of Village of Waunakee and will not be returned.*

    1. Agree
25. I hereby irrevocably authorize Village of Waunakee to edit, copy, exhibit, publish, or distribute this photo for purposes of publicizing Village of Waunakee's programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph.*

    1. Agree
27. I hereby hold harmless and release and forever discharge Village of Waunakee from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other person acting on my behalf or on behalf of my estate have or may have by reason of this authorization.*

    1. Agree
29. Everyone in this photo(s) knows they are in the photo and have given consent to appear in this photo.*

    1. Yes
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31. 1. Receive an email copy of this form.
32. Email address

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33. Submit

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