Child/Youth Photo Release Form
The following authorization is between St. Paul's United Methodist Church, 398 N. Locust St, Elizabethtown, PA 17022, and the Parent/Guardian signing on behalf of the minor Child/Youth. This document supersedes all previously submitted authorizations based on the email and date/timestamp of the submission.
CHILD/YOUTH (Full Legal Name) *
PARENT or LEGAL GUARDIAN (Full Legal Name) of Child/Youth *
Please indicate your preferences below: *
Required
Furthermore, I understand that no royalty, fee or other compensation shall become payable to me by reason of such use. *
By checking this box, I acknowledge that I understand the full extent of this authorization and that I am legally able to provide said authorization for the child/youth listed. I also acknowledge that typing my name acts as an electronic signature. *
Please type Full Legal Name (acts as an electronic signature) *
Email Address *
Date Signed: *
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Phone Number *
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