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      Media Consent Form        
                   
          Blue Ridge Youth Soccer      
                   
                   
    I give Blue Ridge Youth Soccer Association permission to photograph  
    my child, ____________________________________, during the season
        Child's Name          
                     
    for use in ad books, newsletters, and website.  It will be picture only with  
    NO name or personal information given.        
                     
                     
                     
    Please do not take any pictures of my child, ______________________  
              Child's Name    
                     
    while involved with Blue Ridge Youth Soccer Association.    
                     
                     
    Sign & Date____________________________________