UUCPA Adult Photo/Video Release Form For Specific Photos/Video

UUCPA Photo/Video Release Form

For photos/video taken on a specific date or photos specifically attached to this form.
I hereby grant permission to the Unitarian Universalist Church of Palo Alto (UUCPA) to use photographs and/or video of me on the date specified below, taken at the Unitarian Universalist Church of Palo Alto located at 505 East Charleston Road, Palo Alto, CA 94306, or taken during a UUCPA sponsored online video session, or photos/video specifically attached to this form in publications, news releases, online, and in other communications related to the mission of the Unitarian Universalist Church of Palo Alto.
Name

First NameLast Name
Date Photos/Video Were/Was Taken (if release is for photos/video taken on a specific date)

MonthDayYear
Date
Attach photos/video (if release is for specific photos/video)

Browse Files
Photos for which you are providing a release. Cancelof
Email
example@example.com
Phone Number

Area CodePhone Number
Comments
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

UUCPA Photo/Video Release Form