Hope UMC of Pocahontas County SOCIAL MEDIA/NEWSLETTER Release Form

Hope United Methodist Church of Pocahontas County requires student and parent permission to use a person’s photograph, voice, and/or name in various media projects Please answer each section below. When you submit, it will record your response.
FOR CHILDREN UNDER 18 living in your home: *
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Names (first & last) of all children the above applies to: *
FOR MEMBERS/FRIENDS OF HOPE: Pictures *
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FOR MEMBERS/FRIENDS OF HOPE: Birthdays &/or Anniversary *
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If YES (consent) for Birthdays &/or Anniversaries, BIRTHDAY Month/ Day & first person's name *
If YES (consent) for Birthdays &/or Anniversaries, BIRTHDAY Month/ Day & second person's name (If none, put NA) *
If YES (consent) for Birthdays &/or Anniversaries, BIRTHDAY Month/ Day & list additional people's name (if none, put NA) *
If YES (consent) for Birthdays &/or Anniversaries, list your ANNIVERSARY Month & Day *
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Name of person completing permission form: *
Email Address: *
Mailing Address: (street/city/zip code) *
Phone number - Land line: (if none, type NA) *
Phone number - Name & Cell : (if none, type NA) *
Phone number - Second Name & Cell : (if none, type NA) *
Email address for Second Name: (if none, type NA) *
Today's Date: *
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