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Sample Release Form CELC web pubs

Image/ Audio release form


I hereby grant Christ Evangelical Lutheran Church (the organization) permission to use my likeness in photographs, video and audio recordings or electronic images in any and all of its publications, including website entries and our two Facebook pages, without payment or any other consideration. I understand and agree that these materials will become the property of the organization and will not be returned.  I hereby irrevocably authorize the organization to edit, alter, copy, exhibit, publish or distribute these images for purposes of publicizing the organization's programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears.  Additionally, I waive any right to royalties or other compensation arising or related to the use of my image. I hereby hold harmless and release and forever discharge the organization from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. 


Any electronic posting will be done in accordance with the organization’s electronic privacy policy approved by the board in November 2012 which is available in church office.


I am 18 years of age or older and am competent to contract in my own name, or if I am under age 18, a parent or guardian has signed below. I have read this release before signing below and I fully understand the contents, meaning and impact of this release.

Choose One option:

Conditional Release for this date only  ¨    Blanket Approval from this date until rescinded  ¨

Please cancel my prior Release as of this date ¨


_____________________________________________    ________________________

(Signature)                                                                                                                                 (Date)


(Printed Name)


If the person signing is under age 18 we would ask that that person sign but there must also be the signed consent by a parent or guardian, below:


I hereby certify that I am the parent or guardian of _______________________________, named above, and do hereby give my consent without reservation to the foregoing release on behalf of this person.

______________________________________________    ________________________

(Parent/Guardian’s Signature)                                                                                                   (Date)


(Parent/Guardian’s Printed Name)

Creation date: Dec 14, 2012 11:53am     Last modified date: Dec 14, 2012 11:53am   Last visit date: May 25, 2022 6:25pm
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