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