I hereby grant to the Maryland Department of Natural Resources and to its employees, agents and assigns the right to photograph my dependent and use the photo and or other digital reproduction of him/her or other reproduction of his/her physical likeness for publication processes, whether electronic, print, digital or electronic publishing via the Internet.

Model's Signature:

Model's Printed Name:

Address:

I certify that I am a custodial parent and have the aforementioned rights to assign.

Signature of
Parent or Guardian:

Address: