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Image Use Revocation Digital Form
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I do not grant St Andrew's Presbyterian Church permission to publish, in full or in part, any image(s) or video(s) of me, whether in print or in video, that includes me on their website, at the church, or related to social media outlets. I understand that this revocation will remain in force until I withdraw my request and that St Andrew's Presbyterian Church may require me to restate my intentions at some future date.
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Print Legal Name
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*If the individual listed above is a minor* 

The person listed above is a minor. I am the guardian of the above named person and complete the form on their behalf. (If this does not apply, skip and complete the remainder of the form.) 
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E-Signature
By typing your name below, this acts as a formal signature and agreement to the image revocation form. 
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