Photo Release Form 3-2260

U.S. Fish & Wildlife Service

Agreement for Use of Likeness
in Audio/Visual Products
General Release
Event

Date

I hereby grant permission to the U.S. Fish and Wildlife Service (USFWS) to record my name, likeness,
image, voice, and/or sound, at the event specified above, and to place these recordings in the public domain.
As a result of these recordings being voluntarily placed in the public domain, the USFWS, or anyone else, may
freely modify, reproduce, display, and/or distribute them in any media without limitation and without my approval
or permission, with no monetary compensation to me.
The United States will be held harmless and have no liability for any use by any person or entity of the recordings
made subject to this agreement.

Adult
I am at least 18 years of age and am competent to contract in my own name. I have read this release before signing
below and fully understand the content, meaning, and impact of this release.
Printed Name
Signature
Phone

Date
Email

Minor Child (Under the age of 18)
Printed Name of Child/Children/Age
Printed Name of Parent/Legal Guardian
Signature of Parent/Legal Guardian

For Internal Use
Producer

Production Date(s)

Production/Shoot Name
Production Location(s)
Additional Information

FWS 3-2260
04/16