Photo / Video Release Form : St Mark Lutheran Church

Consent*
I grant permission to St. Mark Lutheran Preschool & Childcare Center (SMLPSCC) and its agents and employees the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of me, or members of my family, for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium and without restriction. I hereby release SMLPSCC and its legal representatives for all claims and liability relating to said images or video. I also waive my right to any compensation.
Please list all persons to which this release is applicable:
Parent 1*
Parent 2
Names of Children*
Other
Name/Legal Guardian*
Digital Signature*
Typing your name and agreeing to the above constitutes a digital signature and consent.
Date*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
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