Video Release Form

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VIDEO RELEASE FORM
To Whom It May Concern:
I,
(the undersigned) do hereby confirm the consent
heretofore given you with respect to your photographing or videotaping me or my child/children in connection with
the
Church of Illinois.
And I hereby grant to you, your successor, assigns and licenses the perpetual right to use, as you may desire, all
photographs, motion pictures and soundtrack recordings which you may make of me or my child/children, and the
right to use my name and/or child(ren)’s name or likeness in or in connection with the exhibition or any other use
of such photograph or video.
I release the
Church from any expectation of
confidentiality for the undersigned minor child/children and attest that I am the parent or legal guardian of the
child/children listed below and that I have the authority to authorize the use of their participation in the video.
As these videos are completely voluntary, and I will receive no financial compensation now or in the future, I
release the
Church and its employees from liability for any
claims by me or any third party in connection with my participation.
I have read and understand the above.
Signature
Date
Printed Name
Address
Names & Ages of Minor Children
Name
Age
DOB
Name
Age
DOB
Name
Age
DOB
Name
Age
DOB
Name
Age
DOB
Name
Age
DOB

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