Student Video/Photo Release Form

By filling out the following information, I hereby give School Ministries of Culver, School Ministries, Inc., and their legal representatives and assigns the right and permission to use and publish without charge photographs, videos, or other media of the student listed and their image, or likeness.

These photographs and/or videos may be used in publications, including electronic publications, audio-video presentations, promotional literature, advertising, or in other similar ways.

I hereby signify that I am over eighteen (18) years of age am the parent or legal guardian of the student identified, and am competent in my name.

Student's Name

First Name

Last Name

Parent/Guardian's Name

First Name

Last Name

Check "Yes" or "No" if you give School Ministries of Rock Hill, School Ministries, Inc., and their legal representatives and assigns the right and permission to use/publish any photos/videos taken of student names above.

Yes

No

Date

MM

DD

YYYY

At (locations or events): Held by School Ministries of Rock Hill