Photo Release Form – St. Francis Xavier Church

Student Name*
First Last
Student Name
First Last
Student Name
First Last
Parent / Guardian Name*
First Last
Parent / Guardian Name
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Second Address (if applicable)
Street Address Address Line 2 City State ZIP Code
Phone*
Alternate Phone
Consent*
I agree to the privacy policy.
I (We) parent(s) or guardian(s) of the above name child(ren) do hereby give and grant to St. Francis Xavier Church permission to use my/our child(ren)’s name, photograph, and/or videotaped image in publications and video productions, and on the church app, church social media and/or church website. I/we do further certify that I/we are of full legal capacity to execute the foregoing authorization and release.
Signature of Parent or Guardian*
Signature of Second Parent or Guardian
Date*
Date Format: MM slash DD slash YYYY
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.