Photo Release Form printable pdf download

Photo Release Form

Children’s Center of the First Presbyterian Church

333 West Colfax Avenue

South Bend, Indiana 46601

I, __________________________________ hereby grant The Children’s Center of the First Presbyterian

Church permission to publish in agency publications and/or on the agency website located at

according the identified options below.

(check all applicable boxes) My photographs My spouse’s photographs My child’s photographs

My child’s photograph can be used on the secure portions of the website where only authorized family members

and staff have access.

My child’s photograph can be used in the context of classroom materials. (Cubby’s, job

board, snaps of activities related to experiences, etc.)

I do not want my child’s photographs to be published on the website or any agency

publications that the general public can view.

I do not want my child’s photograph to be published for any reason.

I understand that I have the right to request, in writing, removal of the photo from the website within 30

working days of the receipt of the request by the Children’s Center of the First Presbyterian Church.

I understand that this photo may be used in agency publications or on a website designed to promote the

agency’s services as well as offer information and resources. The Children’s Center of the First Presbyterian

Church is a 501c3 agency.

Signed: ____________________________________ Date: ______________

Photo Release Form