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

  ANNUAL 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 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 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? *
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Signature: *
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412 Lilly Rd. N.E., Olympia, Washington 98506-5132
(360) 867-2588  FAX (360) 867-2600  TDD (360) 867-2603 TDD (800) 658-6384
https://www.co.thurston.wa.us/health