MBP Healthy Living Youth Scholarship Program
Photo Permission Form
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.