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3. 
5. Applicant Type

   1. Individual
   2. Group
7. Participants Name (First and Last Name)(If Group, include Group Name):
9. Background Information on Participant or Group, Recognition/Achievement:
13. Contact Information:
15. Parent of Legal Guardian Name:
17. Address:
19. Phone Number:
21. Email:
25. PHOTOGRAPHIC RELEASE:

    1. I understand that photographs may be taken during this activity and hereby grant the City permission to use any such photo(s) that may include me (or any person for whom I am signing this Release) for advertising or in promotional materials.
    2. I DO NOT grant permission to the City to use any photo(s) that may include me (or any person for whom I am signing this Release) for advertising or in promotional materials.
27. PARENTAL/GUARDIAN CONSENT (to be completed and signed by parent/guardian if Participant is under 18 years of age, if applicable)

    1. I hereby consent that my son/daughter, participate as Pledge Leader at an Irwindale City Council meeting, and I hereby execute this release on his/her behalf. I state that said minor is physically able to participate in said activity. I hereby agree to indemnify and hold the City (including its officers, employees, volunteers, and agents) free and harmless from any loss, liability, damage, cost, or expense which may arise out of or connected in any way with said minor’s participation in said ac
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29. 1. Receive an email copy of this form.
30. Email address

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31. Submit

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