Parental Consent

To: Name of Organization Using Photograph of Child (the "Organization")

For good and valuable consideration, the receipt and sufficiency of which is hereby
acknowledged, the undersigned parent(s) of Name of Child (the "Child"), hereby:

1. Authorize and consent to the Organization taking one or more photographs (the
"Photograph(s)") of the Child for the sole purpose of State Purpose of Use of
Photograph(s) (ie. promoting the Organization in a School Calendar) (the "Purpose").

2. Agree that the Photograph(s) and any royalties, rights, benefits or other privileges
therefrom shall be and become the exclusive property of the Organization and hereby
assign to the Organization, any and all right, title and interest that I may have in and to the
Photograph(s), and further agree to give the Organization all assistance reasonably
required to protect and perfect the Organization's right in the Photograph(s).

By signing below I acknowledge having read and fully understood this document.

Witness Signature of Parent 1

Date Name of Parent 1

Witness Signature of Parent 2

Date Name of Parent 2