Photo / Video Release
Form
Minor Form
I / We,
_____________________________________________________, hereby
c Do give The Worship Center permission;
c Do Not give The Worship Center
permission;
to take photographs and/or videos of my child(ren) or photographs
and/or videos in which my child(ren) may be involved with others for the
purpose of promotional use in printed and/or electronic form. Photos / Videos
may be used on, but not limited, to the church website www.TheWorshipCenterCT.org and
Taking the Heights Campaign Follow-Up Media.
I release legal rights of ownership of the photos /
videos to The Worship Center and discharge The Worship Center from any and all
claims that may or may not arise from the use of the photos / videos.
I am above the age of 18. I have read the foregoing
document and fully understand its contents. I have legal guardianship authority
over said minor.
Printed name of Minor(s):
_________________________________________
______________________________________________________________
Signature of
Guardian: ___________________________________________
Printed Name of Guardian:
________________________________________
GuardianÕs relationship to Minor(s):
_________________________________
Address:
_______________________________________________________
Date:
______ / ______ / _______
Please sign and fax
to 860-228-2730 or mail this form to:
The Worship Center, P.O. Box 1435, Hebron, CT 06248-7435.