Photo/Media Release Form

Photo/Media Release

I hereby certify that I am the parent/guardian of: *

I do hereby grant Wesley United Methodist Church permission to use his/her name, image (photo or video), and/or likeness in any and all of its publications, including website entries, social media posts, and printed materials, among various others. I further give permission to Wesley United Methodist Church to share these images with The Illinois Great Rivers Annual Conference for use in any and all of its publications, including website entries, social media posts, and printed materials, among various others.
I understand and agree that these materials will become the property of Wesley United Methodist Church and will not be returned. I hereby authorize Wesley United Methodist Church and The Illinois Great Rivers Annual Conference to edit, alter, copy, exhibit, publish or distribute these images for purposes of publicizing its programs or for any other lawful purpose.
In addition, I waive the right to inspect or approve the finished product, including printed or electronic copy, wherein his/her likeness appears. Furthermore, I waive any right to royalties or other compensation arising or related to the use of the images. I hereby hold harmless and release and forever discharge Wesley United Methodist Church and The Illinois Great Rivers Annual Conference 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.
I have read this release before signing below and I fully understand the contents, meaning, and impact of this release. I understand that the permissions set forth in this document shall go into effect on the date of my signature below and will remain in effect indefinitely. However, I also understand that future permissions covered by this document can be withdrawn at any point by written request; though the permissions given in this document shall always remain in effect for the dates between my signature below and the written withdrawal.

Parent/Guardian Signature: *

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Parent/Guardian Name (first and last): *

Date *

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