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4th of July Town Photo Submission

  1. Photos in JPG or PNG format.

  2. Electronic Signature Agreement

    1. I hereby grant the City of Anacortes permission to use my photograph in any and all publications for Government or non-government purposes, including web site entries, without payment or any other consideration in perpetuity. I hereby authorize the City of Anacortes to edit, alter, copy, exhibit, publish or distribute this photo. The City of Anacortes reserves the right to review and reject any photo it deems, in the sole discretion of the Parks Director, to be inappropriate or inconsistent with the goals of the project. I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my photo 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 of Anacortes from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf of on behalf of my estate which may have or may have by reason of this authroization. I am 18 years of age or older and am compentent to contract in my own name. I have read this release, and I fully understand the contents, meaning, and impact of this release. I am the parent or legal guardian of the below-named child, and/or desire to be a participant in the City of Anacortes sponsored Virtual Mosaic 2020 Town Photo. It is important to me that I/this child be allowed to participate in this activity. Being fully informed as to these risks and in consideration of the City's allowing me/my child to participate in this sponsored activity I, on behalf of myself and on behalf of the below-named participant child, assume all risk of injury, damage and harm to myself/the child which may arise from the my/my child's participation in the activity. I further agree, individually and on behalf of myself/the below-named child, to release and hold harmless the City of Anacortes, any of its officials, employees, officiating staff, coaches, volunteers and agents and agree to waive any right of recovery that I may have to bring a claim or lawsuit for damages against them for any personal injury, death or other harmful consequences occurring to myself/the below-named child arising out of my/the child's voluntary participation in this activity, including going to and from the activity, except for the sole negligence of the City of Anacortes. I understand that there is no insurance to cover participants and that although precautions will be taken, the nature of any activity allows for the potential of injury. I grant my full and voluntary consent for me/the below-named child to participate in the activity as described above. Please print your name below to verify that you've read the above statement.

  3. Participation Agreement*

    2. I am the parent or legal guardian of the below-named child, and/or desire to be a participant in the City of Anacortes sponsored Virtual Mosaic 2020 Town Photo. It is important to me that I/this child be allowed to participate in this activity. Being fully informed as to these risks and in consideration of the City's allowing me/my child to participate in this sponsored activity I, on behalf of myself and on behalf of the below-named participant child, assume all risk of injury, damage and harm to myself/the child which may arise from the my/my child's participation in the activity. I further agree, individually and on behalf of myself/the below-named child, to release and hold harmless the City of Anacortes, any of its officials, employees, officiating staff, coaches, volunteers and agents and agree to waive any right of recovery that I may have to bring a claim or lawsuit for damages against them for any personal injury, death or other harmful consequences occurring to myself/the below-named child arising out of my/the child's voluntary participation in this activity, including going to and from the activity, except for the sole negligence of the City of Anacortes. I understand that there is no insurance to cover participants and that although precautions will be taken, the nature of any activity allows for the potential of injury. I grant my full and voluntary consent for me/the below-named child to participate in the activity as described above. Please print your name below to verify that you've read the above statement.

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  5. This field is not part of the form submission.