I, as applicant/ parent/ guardian, do hereby authorize the Builders Association of Central PA, Department of Community and Economic Development, and Centre County Government's Office of Adult Services to take photographs of named applicant and authorize the aforementioned and their assigns and transferees to use and publish the same (including use and publication with my name, no name, or a fictitious name, use in the form taken or with intentional or unintentional alternations, and for the purpose of publicity.) I will not receive any compensation or consideration.
By submitting this form and electronic signature, I agree that I have read the WHR application requirement document and understand the above information and that it is true and correct to the best of my knowledge. I authorize the release of this information to the Builders Association of Central PA, Department of Community and Economic Development and Centre County Government's Office of Adult Services.
