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Staying Safe Photo Submissions

  1. Town Seal
    We Are Brookhaven Strong
    Please use the interactive online form below to to submit a photo depicting how you’re staying safe / quarantining.Read press release.

  2. Submit Your Photo Today!

    Show us how you are staying safe and managing life during these very trying times. We ask that you send us a photo that shines some light, shows unity, community resilience and maybe just a little fun, all while practicing social distancing. We will select the “best of” and post on the Town of Brookhaven website, Brookhaven Cable TV Channel 18 and our social media platforms. If you would like to participate, please complete the Photo Release form below and submit your photo today.

  3. Photo Release

    I hereby grant permission to the Town of Brookhaven, New York, its legal representatives, agents, and assigns, without charge, for the use of my photographs, images produced in print and/or electronically, on the Town of Brookhaven’s website, social media sites and/or on Channel 18. This authorization to use such photographs, images is continuous and may only be withdrawn by my specific rescission in written/electronic form. I do give permission by this Release to the Town of Brookhaven and/ or its legal representatives, agents and assigns, to use my name, if provided, in any publication of the within images.

  4. Parental Permission for a Minor (under 18)

    By checking the "I agree" box below, on behalf of my child, I hereby grant permission to the Town of Brookhaven, New York, its legal representatives, agents, and assigns, without charge, for the use of photographs and/or images submitted by said minor, produced in print and/or electronically. This authorization to use such photographs and images is continuous and may only be withdrawn by my specific rescission in written/electronic form. I do give permission to the Town of Brookhaven and/or its legal representatives, agents and assigns, to use the name of the minor subject, if provided, in any publication of the within images.

  5. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

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  7. This field is not part of the form submission.