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Lodge publication consent form

Wagion Lodge #6

Westmoreland-Fayette Council

Boy Scouts of America

Name:           _________________________________

Age:            _________________________________

Position in     _________________________________

I hereby give instructions regarding the use of my / my son's name in the following manner (initial all those that apply, cross out those that do not).

______Name may be identified on the lodge website.

______Picture may be identified with name on the lodge website.

______Scout or Scouter is willing/allowed to receive communication via E-Mail.

______Special @OA6.ORG Wagion E-Mail address may be assigned. This email address will be used only for lodge business and will be used to prevent publication of person's real email address.

______Email contact info may be used by members of the executive committee for discussion or announcements.

______Email contact info may be published in the lodge website.

Signature required (must be signed by a parent/guardian if scout is under age 18.

Signature:      _________________________________

Date:           _________________________________

Relation to     _________________________________
Copyright 2002-2009 Wagion Lodge #6 - Westmoreland Fayette Council, BSA