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Print and mail completed form to:

New Jersey WAVE

c/o  Voorheees Pediatric Facility

Attention: Tricia Cunningham

1304 Laurel Oak Road

Voorhees, NJ 08034-4392

 

NJ WAVE

 

 

CONSENT TO PHOTOGRAPH

 

 NJ WAVE participant shall state whether he/she will consent to be

photographed by NJ WAVE, as follows:

 

(Please check)

 

 A.         __________________   I hereby give my consent to be

photographed (including video photography) by NJ WAVE staff,

media or families of other  WAVE camp participants for purposes

of  advertising or public display.

 

                                     OR

 

B.         __________________  I do not  give consent to be

photographed (including video photography) by NJ WAVE staff,

media or families of other  WAVE camp participants for purposes

of  advertising or public display.

 

 

 _________________________________________________________

NJ WAVE Camp participant/ guardian/ respresentative   Signature    

 

 

Date______________________