Saint Agnes Church Photo/Video Release Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Name: *

Child's Name: (if applicable)

I grant permission to St. Agnes Church located in Clark, NJ, hereinafter known as the “Media” to use my image (photographs and/or video) for use in Media publications including: (Check all that apply) *

Social Media

Videos

Email Blasts

Brochures

Newsletters

Magazines

General Publications

Websites and/or Affiliates

Required

I hereby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image. *

I agree.

Required

Please check below which is applicable to your present situation: *

I am 18 years of age or older and I am competent to contract in my own name. I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.

I am the parent or legal guardian of the above named child. I have read this release and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.

Required

Address: *

Phone Number: *

Email Address: *

Signature: *

Date: *

YYYY

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms