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2. James City County requires use of the photo/video release form in conjunction with Administrative Regulation COAD 3 effective on Jan. 12, 2017.
   
   Thank you for completing this form and supporting James City County!
4. I understand that all photographs, voice recordings, interviews, and/or videos of me/my child may be used and reproduced at the County’s sole discretion for public use by the County and its governmental partners. Governmental partners include, but are not limited to, the Williamsburg-James City County Schools, the Economic Development Authority, the James City Service Authority and the County’s Constitutional Officers. I further extend my permission to provide these images to the media as part of any official James City County government business.
6. I do hereby consent and irrevocably grant authority to James City County, Virginia, its employees, agents and assigns, hereinafter called the “County,” to take photographs, voice recordings, interviews and/or videos of me/my child and use them for the purposes of illustration, presentations, advertisement or publication in any form. This includes, but is not limited to radio, newspaper articles, billboards, brochures, educational/training videos, County websites and social media sites and County public cable channels.
8. I do hereby waive any right to inspect or approve the finished photographs, voice recordings, interviews and/or videos of me/my child, and the manner in which they may be used.
10. Electronic Signature Agreement*

    I have read this release, fully understand its terms, and acknowledge that I am signing the release freely and voluntarily and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.

    1. I agree.
12. First Name*
13. Last Name*
15. Child's Name (if applicable)
17. Email
18. Phone
20. Address
21. City
23. State
24. Zip Code
26. Electronic Signature*
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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field