National Charity Roundtable Consent Form printable pdf download

National Charity Roundtable Consent Form

NATIONAL CHARITY ROUNDTABLE

CONSENT FORM

Knight/Squire/Page Name _________________________

Class of __________

Photographs taken at our meetings and events may include images of your son. We may

use these images in our scrapbook, news and other media publications, our website and

possibly in videos.

There will also be times that our chapter may be visited by the media who will take

photographs or film footage of an event or philanthropy. Knights, Squires, and Pages

may appear in these images which will be published in local or national newspapers or on

televised news programs.

NCR needs your permission before we can photograph or make any recordings of your

son. Please answer the questions below, sign and date this document and return it to

National Charity Roundtable as soon as possible.

Circle one

May we use your son’s photograph in the NCR directory, website

or other printed publication that NCR produces?

Yes

May we record your son’s image on video?

Yes

Can your son’s image appear in the media?

Yes

Can your son’s image be sent to other NCR members

in electronic format as an e-mail attachment?

Yes

I have read and I understand the conditions of use of this form.

___________________________________

Date: ___________________

Parent’s or Guardian’s Signature

Printed Name of Parent or Guardian: ________________________________

__________________________________

Date: ____________________

Witness Signature

Printed Name of Witness: __________________________________________

This form is valid for six (6) years from date of signature, and will automatically expire

after that date.

National Charity Roundtable Consent Form