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Wall of Fame
By filling out and signing the online form below, I grant Countryside Feed, LLC full rights to use the image(s) of my child for fundraising, publicity or other purposes to help achieve the companies aims. This may include (but not limited to), the right to use them in their printed and online publicity, social media, press releases and funding applications
Waiver to Release Pictures
2020 Wall of Fame T-Shirt
*First Name of Person in Photo:
*Last Name of Person in Photo:
*Email (Parent/Guardian):
*Address:
*Phone Number:
*Date of Photo:
Calendar
Today
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*Photo Upload:
*Is there a minor in the picture?:
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No
Parent/Guardian Electronic Signature:
Only if you answered "yes" to the previous question
*Is this a Wall of Fame picture?:
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No
T-shirt Size:
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