Immaculate Conception Church Vacation Bible School 

CONSENT AND RELEASE OF LIABILITY FOR USE OF MINOR’S LIKENESS AND OTHER INFORMATION 

I (We) the parent(s) and/or guardian(s)hereby grant consent for Immaculate Conception Church (“Parish”), and/or its agents to record (in  writing or otherwise), photograph, audiotape, or videotape my minor child’s name, image, likeness, spoken words, student work,  and/or performance, in any form, and to display, release, exhibit, publish, or distribute the same, or any part thereof, for the purpose  of and in connection with any material that may be created by or on behalf of the Parish including, without limitation, Parish  bulletin boards; the Parish’s weekly bulletin; the Parish’s website; print and electronic media; Parish marketing, public relations and  communications materials and/or presentations; and such other uses as may not be contemplated herein, without further notice or  compensation as follows:

I further understand that by entering into this informed consent and release, and by granting permission as stated herein, I hereby release Immaculate Conception, Madison, the Diocese of Cleveland, and their respective officers, directors, agents and/or employees from and against any and all liability, loss, damage, costs, claims, and/or causes of action arising out of or related to the above items to which I have consented. 

I further understand that the Parish and its respective officers, directors, agents and/or employees have no control over use of photographs, videotapes, audiotapes, or other records made by others and/or outside the scope of this consent and release. 

Finally, in signing below I acknowledge that all recordings, audiotape, videotape, photographic proofs, photographic negatives, positives, and prints shall constitute the property of the Parish. I have carefully read and understand and accept the terms and conditions stated herein and I have signed this agreement of my own free will. For Online Forms Add: By typing my name below, which shall constitute my electronic signature, I agree that my electronic signature is intended to authenticate this writing and to have the same force and effect as my manual signature.

Signature of Parent(s)/Legal Guardian(s)

PART A OR B MUST BE COMPLETED 

PART A: TO GRANT CONSENT:

I hereby give consent for the following medical care providers to be called:

I have carefully read and understand and accept the terms and conditions stated herein and I have signed this agreement of my own free will. For Online Forms Add: By typing my name below, which shall constitute my electronic signature, I agree that my electronic signature is intended to authenticate this writing and to have the same force and effect as my manual signature.

PART A OR B MUST BE COMPLETED

PART B: REFUSAL TO CONSENT: