HSWAGATA BUDDHA TOOTH RELICS PRESERVATION MUSEUM
MEDIA / PHOTOGRAPHY PERMISSION FORM
Form Code: HSW-F48
Event / Visit Title: ____________________________
Date: ____ / ____ / ______
1. PARTICIPANT DETAILS
1.1 Name (or group name): _____________________
1.2 Contact (optional): _______________________
2. PERMISSION
I understand that photos and/or video may be taken during
this event or visit.
I agree / do not agree (please tick):
[ ] I AGREE that photos or video of me may be used for:
[ ] Museum website
[ ] Printed materials
[ ] Social media
[ ] Reports to donors
[ ] I DO NOT AGREE that photos or video of me are used.
3. CONDITIONS (OPTIONAL)
Please write any conditions. Example: “No tagging my name
on social media”, “Use only in printed reports”, etc.
_____________________________________________
_____________________________________________
4. SIGNATURES
Participant (or parent/guardian if needed):
Name: ________________________________________
Signature: ______________ Date: ____/____/____
Museum Representative:
Name: ________________________________________
Signature: ______________ Date: ____/____/____
