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MBP Healthy Living Youth Scholarship Program

Photo Permission Form

Date: __________________

I ______________________________________ who is the parent/guardian of my son/daughter______________________________ hereby give permission to supply a  decent photo along with a blog about themselves to the authority of MBP Healthy Living Youth Scholarship Program for the sole purpose and use of posting it on the scholarship website.  The photo will be in possession of the program and will not be used for any other purpose other than recognition of being a participant. 

Print Name: __________________________________


Please print this page and mail it to the address listed below along with a photo and blog.


MBP Healthy Living for Youth Scholarship Program
MBP Healthy Living Inc.

2126 Lakeview #195
Ypsilanti, Mi 48198
mbpscholarshipprogram@gmail.com (for students)

This organization practices equal opportunity and affirmative action for all under the guidance and regulations of the Equal Employment Opportunity Commissions (EEOC).