Disability Mentoring Day 2006

PHOTO RELEASE FORM
[City Name] Area

Return by Fax to (___) ___-____ or
Return by Email to [Email Address]


TO BE COMPLETED BY ALL PARTICIPANTS

PHOTO RELEASE. I understand that Disability Mentoring Day can attract attention 
from the media and that it is used to promote ongoing partnerships between schools, 
disability organizations, and employers. I hereby grant permission to be photographed 
for promotional and educational purposes.

________________________________________        ______________
Signature										Date

________________________________________
Printed Name



________________________________________        ______________
Parent or legal guardian if under 18			Date

________________________________________
Printed Name







____________________________________________________________________________

American Association of People With Disabilities (AAPD)
1629 K Street NW, Suite 503, Washington DC 20006
Phone: 202-457-0046/800-840-8844 * Email: dmdaapd@aol.com * www.dmd-aapd.org