Form DACS-11295 State Forest Photo Contest Photograph Submission / Release Form - Florida

Form DACS-11295 or the "State Forest Photo Contest Photograph Submission / Release Form" is a form issued by the Florida Department of Agriculture and Consumer Services.

Download a PDF version of the Form DACS-11295 down below or find it on the Florida Department of Agriculture and Consumer Services Forms website.

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Florida Department of Agriculture and Consumer Services
Florida Forest Service
STATE FOREST PHOTO CONTEST
PHOTOGRAPH SUBMISSION / RELEASE FORM
ADAM H. PUTNAM
COMMISSIONER
Photographer’s Name:
Address:
Email:
1
Name of
Date
2
State Forest
Category
Description of Photograph/Alterations
Photograph
Taken
1
Please note that the name of the photograph listed needs to match the name of the photograph file submitted by email or CD.
2
Categories are: (1) Nature, (2) Recreation, (3) Creative or (4) Employee.
I do hereby make the following statements, releases, assignments and assurances to the Florida Department of Agriculture and
Consumer Services (“Department”): I have read the State Forest Photo Contest Rules, I certify that I ("Photographer") am the person
who took the photograph(s) submitted herewith (collectively, the "photographs"), and I have not assigned any of my rights associated
with the photographs to any third party and have sole, complete and unrestricted authority to enter into this release and to grant the
rights described in this release. I release the Department from any liability whatsoever that arises from their use of the photographs
except for uses that violate the terms and conditions of this release. I hereby grant the Department the royalty-free and nonexclusive
right to distribute publish and use the photograph(s) in publications to promote Florida’s state forests and the Department or to use as
they see fit.
Print Name of Photographer
Signature of Photographer
Date
CONSENT OF GUARDIAN
I am the parent or legal guardian of the above named minor and hereby approve the above release and waive any rights
in the premises.
Print Parent/Guardian Name
Signature Parent/Guardian
Date
DACS-11295 Rev. 12/12
Florida Department of Agriculture and Consumer Services
Florida Forest Service
STATE FOREST PHOTO CONTEST
PHOTOGRAPH SUBMISSION / RELEASE FORM
ADAM H. PUTNAM
COMMISSIONER
Photographer’s Name:
Address:
Email:
1
Name of
Date
2
State Forest
Category
Description of Photograph/Alterations
Photograph
Taken
1
Please note that the name of the photograph listed needs to match the name of the photograph file submitted by email or CD.
2
Categories are: (1) Nature, (2) Recreation, (3) Creative or (4) Employee.
I do hereby make the following statements, releases, assignments and assurances to the Florida Department of Agriculture and
Consumer Services (“Department”): I have read the State Forest Photo Contest Rules, I certify that I ("Photographer") am the person
who took the photograph(s) submitted herewith (collectively, the "photographs"), and I have not assigned any of my rights associated
with the photographs to any third party and have sole, complete and unrestricted authority to enter into this release and to grant the
rights described in this release. I release the Department from any liability whatsoever that arises from their use of the photographs
except for uses that violate the terms and conditions of this release. I hereby grant the Department the royalty-free and nonexclusive
right to distribute publish and use the photograph(s) in publications to promote Florida’s state forests and the Department or to use as
they see fit.
Print Name of Photographer
Signature of Photographer
Date
CONSENT OF GUARDIAN
I am the parent or legal guardian of the above named minor and hereby approve the above release and waive any rights
in the premises.
Print Parent/Guardian Name
Signature Parent/Guardian
Date
DACS-11295 Rev. 12/12
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