UUCPA Minor Child Photo Release Form For Photos Taken On A Specific Date

UUCPA Minor Child Photo Release Form

For photos taken on a specific date or photos specifically attached to this form.
I, the Parent/Guardian of the minor child named below, hereby grant permission to the Unitarian Universalist Church of Palo Alto to use photographs and/or video of my child (named below) taken on the date shown below at the Unitarian Universalist Church of Palo Alto located at 505 East Charleston Road, Palo Alto, CA 94306 or photos/video 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.

Furthermore, I understand that my child’s name will not appear in these publications.
Minor Child's Name

First Name Last Name
Date Photos/Videos Were Taken

Month Day Year
Date
Attach photos (if release is for specific photos)

Browse Files
Photos for which you are providing a release. Cancel of
Parent/Guardian Name

First Name Last Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number

Area Code Phone Number
Comments
Parent/Guardian Signature

Clear
Date

Month Day Year
Date
Should be Empty: