World Photo Day Contest

Your Full Name
First and Last Name *This question is required.

By selecting "Agree" below, I hereby grant the City-Cowley County Health Department permission to use the photograph submitted below for use in any and all of its publications, including web-based publications, without payment or other consideration. I hereby irrevocably authorize the City-Cowley County Health Department to edit, alter, copy, exhibit, publish or distribute this photograph for any lawful purpose. I waive the right to inspect or approve the finished product including written or electronic copy wherein the photograph appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge the City-Cowley County Health Department from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. *This question is required.

I am 18 years of age or older and am competent to contract in my own name. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.

Sign and print your names below: *This question is required.

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Please upload your photo below: *This question is required.

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If your photo is selected for the contest, what is your preferred contact method? *This question is required.

Phone Number: *This question is required.

Email Address: *This question is required.