Photo day Release Form Blackland Prairie Raptor Center 1625 Brockdale Park Road Lucas, TX 75002 Permission to Photograph: Subject: Education Raptors Location: Brockdale Park Photographs taken of Blackland Prairie Raptor Center’s (BPRC) education raptors are for personal use only and are not to be reproduced, sold, or used electronically in any form without written permission by the Executive Director of BPRC as promulgated by the United States Fish and Wildlife Service. I agree to acquire written consent for any use of photographs taken of Blackland Prairie Raptor Center’s Education Raptors at Brockdale Park, for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. I have read and understand the above: Name(Required) First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date MM slash DD slash YYYY Signature 45268
