Photo Release Permission Form

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Email *

I hereby consent First Evangelical Lutheran Church of Beaver Dam, WI, the right to use any photographs and/or video-recordings taken of me and/or my family on the church premises (worship, Sunday School, etc.) and/or any Youth & Family Events for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources). I do this with full knowledge and consent and waive all claims for compensation for use, or for damages. Please check one box that applies to you and your family: *

I consent to be photographed and video-recorded in all the ways listed above.

I consent to only be photographed or video-recorded for use within the church ONLY.

I do not consent to be photographed or video-recorded.

Required

Please list the names of all immediate family members to be included under this agreement (i.e. spouse and/or children): *

Signature: *

I understand by typing my first and last name below constitutes my signature confirming my agreement with the terms set in the above document.

Send me a copy of my responses.

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