South Hills Catholic Academy Records Release Form

South Hills Catholic Academy Publicity Authorization Form

South Hills Catholic Academy Registration Requires Completion of this Form
Permission is hereby granted to SOUTH HILLS CATHOLIC ACADEMY to use voice recordings, photographs, video, and quotations of:

First Name

Last Name

Entering Grade

Student #1

Student #2

Student #3

Student #4

to assist in its community awareness, educational efforts, and related public relations purposes. In exchange for the opportunity to participate in the community awareness programs, educational efforts, and related publicity endeavors of SOUTH HILLS CATHOLIC ACADEMY, I hereby agree to indemnify and hold harmless SOUTH HILLS CATHOLIC ACADEMY, their agents and employees from any and all claims, demands, and/or causes of action of whatever kind or nature arising from the use of voice recordings, photographs, video, and quotations.

I further agree that I waive any right to compensation, fee, or royalty for myself, my successors, heirs, or assigns for the production or use of the aforesaid materials.
Please Check One: *

Yes, images may be used for SOUTH HILLS CATHOLIC ACADEMY publicity efforts. I do not wish images to be used for SOUTH HILLS CATHOLIC ACADEMY publicity efforts.
Please Complete
Parent / Guardian Name *

First Name Last Name
Relationship to Child *
Parent / Guardian Address *

Street Address

Street Address Line 2

City State

Zip Code
Date *

Month Day Year
Date
Please Sign

IMPORTANT: You must click "FINISH" on the DocuSign site to complete the signature process. If "FINISH" isn't clicked, we will not receive your document.
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South Hills Catholic Academy Publicity Authorization Form