Name *

First Name

Last Name

Phone

(###)

###

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1st Parent's/Guardian's Name

First Name

Last Name

1st Parent's/Guardian's Phone

(###)

###

####

2nd Parent's/Guardian's Name

First Name

Last Name

2nd Parent's/Guardian's Phone

(###)

###

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Media Release *

1. Use and storage of my (or my child’s) image, by means of digital or film photography, video photography, audio recording, or other documentation, with respect to the activity of the Church for which I am registering. 2. Use of any stored data including my (or my child’s) image in printed publications of the Church. 3. Use of any stored data including my (or my child’s) image in electronic publications or social media accounts of the Church. 4. Use of any stored data including my (or my child’s) image in any Web site created by or for Church. 5. Storage of my (or my child’s) name in association with any image, but not permission to use such images in any public setting unless I specifically authorize Church to do so. 6. If I am entering this agreement on behalf of a minor child, I hereby warrant that I am the legal parent or guardian of the child and that I have the legal authority to enter this agreement on behalf of the child. 7. If a dispute over this agreement or any claim for damages arises, I agree to resolve the matter through a mutually acceptable alternative dispute resolution process

Option 1

Option 2