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Youth Photo Release Form

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I give permission for my minor child, _____________________________, 
                                          Print name of child

to appear in a photograph on the Bicycle Coalition of Maine (BCM) website.


                            ___________________________
                            Print name of parent or guardian
							
                            ___________________________
                            Signature of parent or guardian
							
                            ____________________________
                            Date

All photos showing children under 18 must include a signed release form mailed to: Shoshana Hoose, Bicycle Coalition of Maine, PO Box 5275, Augusta ME 04332.