PERMISSION TO USE PHOTOGRAPHS/VIDEO

PERMISSION TO USE PHOTOGRAPHS/VIDEO
Family Name*
Home study writer*
Home study writer is assigned after training is completed. If you have not completed training, please mark "Other or Unknown."
I understand that AGAPE publishes a quarterly newsletter and uses other media, including but not limited to a web site, and Face Book to inform supporters of AGAPE's services and to recruit foster and adoptive parents. I give permission for AGAPE to use pictures or video footage of my child(ren) and/or myself or my family for the purpose of sharing information about AGAPE's programs and activities. I understand and agree that the use of these pictures will not constitute a release of any identifying information about my child, myself, or my family other than first names. Disclosure of any indentifying information will only be done with my specific permission.
Parent or Individual

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Signature

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Signature of child over the age of Eleven (11)

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Signature of child over the age of Eleven (11)

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Signature of child over the age of Eleven (11)

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MonthDayYear
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Signature of child over the age of Eleven (11)

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Should be Empty: