Media Release Form

Media Release Form

First Name*

Last Name*

Email*

Children's Name(s)

Comments

Permission/Refusal of Permission to Publish Images and Names

St. Michael’s by-the-Sea Episcopal Church, its employees or agents, on occasion take photographs, videotape, or digital recordings of the people participating in parish events, to use in any and all media exclusively for the purpose of 1) reporting on the church’s activities through the church printed and electronic newsletters, web site, Facebook page, and press releases; and 2) to promote future activities to be held at or by St. Michael’s by-the-Sea.

Photo Release Waiver*

Yes I permit St. Michael's by-the-Sea Episcopal Church to publish images and names.No, I do NOT permit St. Michael's by-the-Sea Episcopal Church to publish images and names.

I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement.

Signature

Type what you see*