North Street Christian Reformed Church Photo Release Consent Form printable pdf download

North Street Christian Reformed Church

Photo Release Consent Form

I hereby consent to be interviewed, photographed, filmed, videotaped, have my voice recorded, and/or

have my personal likeness recorded through other visual means (collectively, referred to as “Personal

Images”), and authorize the North Street Christian Reformed Church to use, release, publish, exhibit, post

on the Internet, in CD-ROMs or any other medium any of my Personal Images.

By signing this form, I hereby give permission to North Street Christian Reformed Church to use my

Personal Images in whatever medium deemed appropriate by North Street Christian Reformed Church for

any of the following purposes: (i) public relations; (ii) training and education; (iii) advertising; (iv) research;

and/or (v) online, in-store, internal, external sales and marketing activities.

I understand that information about myself/my child may be included in the advertising and publicity

material created by North Street Christian Reformed Church, and I agree that this authorization includes

such use.

I hereby waive all my rights to inspect and approve the finished product, its use or such written or spoken

copy as may be used in connection therewith.

I also waive all rights and release North Street Christian Reformed Church, its officers, agents and

employees, and each and all persons involved in creating my personal Images from any liability connected

with the taking, recording, filming or publication of said interviews, photographs, slides, computer images,

videotapes or voice recordings.

I declare that I am eighteen (18) years old or older and am legally competent to execute this Consent and

Release Form or that I have acquired the written consent of my parent or legal guardian. I understand that

the terms herein are contractual and not a mere recital, and that this Consent and Release Form is legally

binding on me.

Individual’s Name: _________________________________________________________________

Individual’s Signature: ______________________________________________________________

Phone Number: ___________________________________________

Date: ________________

North Street Christian Reformed Church Photo Release Consent Form