Parental Consent and Liability Release Form


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AC UM C Ph o t o R el e as e F o r m f o r C h i ld re n a n d St u d en t s

I agree that Armstrong Chapel United Methodist Church may photograph and record my child/dependent’s likeness and activities (Images) 1 during church-related activities. I grant the following rights to ACUMC: permission to use and re-use, publish and re-publish, and modify or alter the Image(s) taken. Use of the Images for editorial, commercial, trade, advertising, and any other purpose may be done in any medium now existing or subsequently developed, on the church website, social media and on the Internet, and worldwide in perpetuity for the purposes stated above.

I waive my right to inspect or approve any editorial text or copy that is used in connection with the Images and release and discharge ACUMC from any and all claims arising out of use of the Images for the purposes described above, including any claims for libel, invasion of privacy, or other tortuous act.

I have read the foregoing. I fully understand its contents, understand that this agreement does not expire, and confirm my agreement by signing below. I am over the age of 21 and have legal capacity to sign the release.



I DO NOT consent to images of my student being used in any form outlined above. I will provide an electronic picture of my student for exclusionary purposes.

Student’s Name (print)

Parent/Guardian Name (print)

x

1

Parent/Guardian Signature

Date

Street Address

City, State, Zip

Parent/Guardian Email

Phone

Im ag e mea n s al l p hot og ra ph s, f il m , or ot her re c ord in g s t ak en o f y ou as p art o f t he S ho ot .

Armstrong Chapel UMC

5125 Drake Rd. Cincinnati, OH 45243

513-561-4220