The Presbyterian Church in Chinatown Photo & Video Release Form
Email address *
I hereby grant the Presbyterian Church in Chinatown (PCC) and Presbyterian Church, (USA) permission to use my likeness in a photograph, video, or other digital media ("photo") in any and all of its publiscations, including web-based publications, without payment or other consideration.

I hereby hold harmless, release, and forever discharge the Presbyterian Church in Chinatown and Presbyterian Church (USA) from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I HAVE READ AND UNDERSTAND THE ABOVE PHOTO & VIDEO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY THEIR SIGNATURES BELOW.
Printed Name *
Your answer
Signature (type in your name as your signature) *
Your answer
Date *
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If under 18, ONE PARENT/LEGAL GUARDIAN MUST SIGN
Parent or Legal Guardian Signature (type in name)
Your answer
Date
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