PUBLIC HEALTH and SOCIAL SERVICES
David Bayne - Director
Dr. Dimyana Abdelmalek - Health Officer                                                                                                                                                                                                                                                                                                                                                                                                                            
COUNTY  COMMISSIONERS 
Carolina Mejia District One
Gary Edwards  District Two
Tye Menser     District Three

  PHOTO RELEASE FORM

The release below must be signed by the person authorized for signing legal documents.
I give my permission to be photographed and/or to have my child or children herein named, to be photographed with the understanding that the pictures may be used for promotional purposes by Thurston County Specialized Recreation Services.

Please select all that apply: *
Please choose one: *
If not the above named participant, have you reviewed this release with the participant named above? *
 +
Signature: *
clear
412 Lilly Rd. N.E., Olympia, Washington 98506-5132
(360) 867-2679  FAX (833) 499-1806  TDD (360) 867-2603 TDD (800) 658-6384
https://www.co.thurston.wa.us/health