Fill and Sign the Tdcj Timesheet Form

CONSENT FORM I hereby grant to the Stark County Safety Council (SCSC) of the Canton Regional Chamber of Commerce, and its designees or assignees, my consent to use, in whole or in part, my photographic image, as incorporated in the photograph/s submitted by: ___________________________________________________________ (Print Name Clearly) to the “Get the Picture? Photo Contest,” for the purpose of reproducing, distributing, displaying publicly, and/or modifying the photo by any means, whether in print or electronically, on a royaltyfree, worldwide basis. In regard to the use of these photographic images, I hereby waive any right that I may have to monetary compensation, or to inspect or approve the finished product, or the advertising or other uses made of the product. I also release SCSC and its designees or assignees from any and all liability that may or could arise from the taking and use of these photographic images. I have read and understand the assignment and release conditions described above. All of my questions concerning this form have been answered to my satisfaction. (Submit questions to scsc@cantonchamber.org, or send written questions to: Jacqueline Bollas Caldwell, SCSC Photo Contest Coordinator, c/o Krugliak, Wilkins, Griffiths & Dougherty Co., L.P.A., PO Box 36963 Canton, OH 44735-6963.) Signature: _____________________________________ Date: _______________ (Parent or Guardian Must Sign for a Minor) Name: ____________________________________________________________ Address: ___________________________________________________________ E-Mail: _________________________ Phone: ____________________________