Photo Release English – Saint Rose of Lima Catholic Church

Child's Name
Photo/Video/Media Release Form & Release to Feature Student's Work
The Diocese of Monterey Parish & School Corporation, also known as and referred to as "Diocese of Monterey," are making a concentrated effort to promote the positive activities, honors, and work of our students. This effort includes working with the local media (newspapers, radio and television stations) and also developing our own publications. These publications include information, likenesses, and images, which may appear on websites of the Diocese of Monterey and its parishes, as well as in other publications.
During the time your child is a participant at
Parish,
a parish of the Diocese of Monterey and herein referred to as "Parish," there may be opportunities for various students to be interviewed and/or photographed and identified by full name and Parish. We understand that some parents may request that we do not identify their child. Plese complete the form below to inform Parish of your wishes regarding publicity (complete a separate form for each child). Please note, however, that your child's image or likeness may appear in occasional candid or group activity photos/videos without any type of name identification and the use of these types of photos/videos of your child is permissible.
Student Name (print):
Last First Middle
Parent/Guardian Name (print):
Last First Middle
Please initial in box:
1. I give permission for my child to be interviewed, identified, photographed or filmed for use in I 1. Diocese of Monterey and Parish publications, including, but not limited to, publication via website or other technological publications, videos, newspapers, radio, television, or development and fundraising materials.
2. I do not give permission for my child to be interviewed, photographed or filmed as indicated in #1. 2.
By signing this release, I acknowledge that I hereby release and forever discharge the Diocese of Monterey and its officers, agents, and employees from and against any and all claims, damages or suits which may arise from the use of the Diocese of Monterey and/or Parish publications, press/media releases, or website, including, but not limited to, the activities and publicity mentioned above. If Parish does not receive this form from me, Parish will assume that I do not grant any of the permissions requested in this form. I understand this form will be kept on file at School. If a situation arises that may change my child's status regarding publicity, it is my responsibility to notify Parish in writing as soon as possible. New release forms will be required each school year.
Parent/Guardian Signature
Parent/Guardian Signature
Date
MM slash DD slash YYYY

Date

Photo/Video/Media Release Form & Release to Feature Student's Work