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  1. Photo/Video Consent Release

    By typing my name in the box below I hereby provide consent and authorize City of Urbandale to reproduce, publish, circulate or otherwise use for promotional purposes any of the following of mine or of the minor for which I am the parent or guardian: name, portrait, photography/video, and/or voice in publications, billboards, radio and television commercials, advertisements, websites and all other forms of marketing and/or communications and I hereby release the City of Urbandale of and from any and all rights, claims, demands, actions or suits which I may or can have against it or its employees or agents on account of the use, publication and/or broadcast of said materials.

  2. Please type the name of the location or the event where your image was captured.

  3. Please type the date your image was captured.

  4. First and last name
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