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Parent Consent and Information Form

Mothers Name: Fathers Name: Email: Phone: Babys Name: Sex: M Date of Birth:
CLEAR FORM

I (we) hereby give permission/authorization for Barton Memorial Hospital and the Tahoe Daily Tribune to use this information and photo for publication in the 2012 edition of Babies-A Keepsake Edition.
After filling out the form above, click the submit button and attach your babys photo to the email. SUBMIT FORM If your email doesnt appear, save the pdf to your desktop and attach to an email and send to: nschue@tahoedailytribune.com Subject: Babies of 2011 Submission BE SURE TO INCLUDE YOUR DIGITAL PHOTO!! Submissions must be received electronically or by hardcopy (mailed) by April 13, 2012. ATTN: Babies of 2011 Submission 3079 Harrison Ave. South Lake Tahoe, CA 96150 (530) 541-3880 Once it is published, you may go by the Tahoe Daily Tribune office to pick up a copy. Photos will not be mailed back, but may be picked up from the Tahoe Daily Tribune once published. Thank you!

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