Highrock Acton Pen Pals
Thank you for your interest in Highrock Acton's Pen Pal Program! Please complete all fields and we will contact you as soon as we have a match for your child! Questions? Please contact phyllis@highrockacton.org.
Email address *
Parent/Caregiver/Guardian (First Name) *
Parent/Caregiver/Guardian (Last Name) *
Participant First Name *
Participant Last Name *
Participant Age *
Participant Gender *
Participant wishes to be paired with a pen pal who is: *
Mailing Address *
City *
State *
Zip Code *
Media Release *
Photos and/or video may be taken throughout the year and summer at various Kidsrock programming and other church programming, including small group activities, retreats, family camp and/or other camps. It is Highrock Church's practice to preserve and make available for dissemination media at events sponsored by the Church. Thank you for granting Highrock permission to use your image in Highrock communications! By clicking YES, I hereby grant permission to the rights of my child and/or family as well as my image as recorded on film or video without payment or any other consideration. I understand that may image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness (or my child's or my family's) appears. I waive any right to royalties or other compensation arising or related to the use of my image (or my child's or my family's), work, or recording. I also understand that this material may be used in diverse settings withing an unrestricted geographic area. This permission signifies that photographic or video recordings of me (or my child or my family) and/or my work (or my child's or my family's) may be electronically displayed via the internet or in a public setting. I acknowledge that I have read and understood this document and have chosen to give the non-exclusive rights to Highrock Church. All permissions granted by me herein shall be effective in perpetuity and apply to any Highrock Church agents and distributors. By clicking NO, I (or my child or my family) wish to be excluded from photos/videos taken at any time. I understand that by checking this box, my (or my child's or my family's) face will be occluded or removed in any photos and videos from Highrock communication. ***This does not limit participation****
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