General Video Picture Release Form printable pdf download

General Video Picture Release Form

General Video/Picture Release Form

___________________________

Name of Photographer/Recorder

___________________________

Address

I hereby consent to and authorize the use and reproduction by you and anyone

authorized by you, of any and all photographs or other types of images, voice recordings

and/or video that you have this day taken of me or recorded, with or without my name,

for any purpose whatsoever, including, without limiting the promotion and activities of

and for the Church of the Nazarene and its affiliated ministries.

I am 18 years of age or older.*

Date:____________________

Location:______________________

Name: (print)__________________________

Signature:_____________________________

Phone:________________________

Address:________________________________________________________________

*(If a minor, the following should also be signed by the parent or guardian.)

Date: _____________

I am the parent or guardian of the minor named above, and I hereby

grant consent on behalf of the minor and myself.

Name: (print) __________________________

Signature:_____________________

Relationship:___________________________

Phone:________________________

Address:________________________________________________________________

General Video Picture Release Form