RADIUS CHURCH MODEL RELEASE

I hereby grant Radius Church, Inc (aka Church) permission to publish photographs, videos, or other images of me procured on Church property and/or at a Church appoved activity(ies) at another location. I authorize Church to use my likeness in photograph(s) or video(s) in any and all kinds of Church's publications and in any and all other media. I will make no monetary or other claim against Church for the use of such photograph(s) or video(s).

Model's Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Model Release is for a person who is:*

Under 18 years of age and is not emancipatedOver 18 years of age

I, the signer, am the parent or legal guardian of the above named and have the legal authority to execute this release on his/her behalf. I have read the fully undertood contents of this release, and consent to the use of said photograph(s) and/or video(s) based on the contents of this release.

Esign Act and EUTA Disclosures: By entering my email, I verify that I have carefully read this MODEL RELEASE between myself and Radius Church, Inc. and consent to signing this document electronically.

Signer's Email*

example@example.com

Signature*

Parent/Legal Guardian Signature*