Texas State Rifle Association

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The release(s) must be signed by any individual(s) shown in your photo(s).

MEDIA RELEASE

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First Name *

Last Name *

Email *

Mailing Address *

Mailing Address 2

Mailing Address City *

Mailing Address State *

Mailing Address Zip *

I am 18 years of age or older and I am competent to contract in my own name. I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so as a free and knowledgeable acceptance of the terms of this release. *

Yes

I am the parent or legal guardian of the child named below. I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release. *

Yes

I DO / NOT give permission for my image or my child’s image to be used. *

Yes

USE OF MEDIA RELEASE? (Name of Event) *

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