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______________________