Parent Release Form for Media Recording
I, the undersigned, do hereby grant or deny permissi=
on to
Yellow Frame Presbyterian Church to use my the image, <=
/span>, as marked by my select=
ion(s)
below. Such use includes the display, distribution, publication, transmissi=
on,
or otherwise use of photographs, images, and/or video taken me for use in
materials that include, but may not be limited to, printed materials such as
brochures and newsletters, videos, and digital images such as those on the
Yellow Frame Presbyterian Church Web site.
q Deny permission to use my image at all.
q Grant permission to use my image in the following wa=
ys
(mark all that apply):
q&nb=
sp; Limited
usage: I want my image without my name used within the Yellow Fr=
ame
Presbyterian Church setting only (not in the larger community).
q&nb=
sp; Limited
usage: I want my image without my name used on printed materials
only (no digital or video use).
q&nb=
sp; Unrestricted
usage: I give unrestricted permission for my image and name to be used =
in
print, video, and digital media. I agree that these images may be used by
Yellow Frame Presbyterian Church for a variety of purposes and that these
images may be used without further notifying me.
Parent/guardian
signature____________________________=
_____ Date_________________
Please make a copy of this form for your own r=
ecords
and mail or fax the original to:
Yellow=
Frame
Presbyterian Church
1 Yellow Frame Road
Newton, NJ 07860
Fax (973) 383-5652
<=
/p>
If you have questions, contact Yellow Frame
Presbyterian Church at Phone (973) 383-5364.
=
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