Church Media Release Form

Church Media Release Form
I certify that I am 18 years of age or older, or am the parent or legal guardian of a minor child, and hereby grant the entities selected below permission to use my likeness in a photograph or video in any and all publications of the entities, including website and social media entries, without payment or any other consideration. I hereby authorize entities selected below to edit, alter, copy, exhibit, publish or distribute such photo or video for purposes of publicizing programs, including the Episcopal Diocese of Hawai‘i’s online publication, The Hawaiian Church Chronicle, websites, and social media pages.
This release applies to (select all that apply)*

A Cup of Cold WaterAll Saints' Episcopal ChurchCalvary Episcopal ChurchCamp Mokulē‘iaChrist ChurchChrist Memorial Episcopal ChurchEmmanuel Episcopal ChurchEpiphany Episcopal ChurchGood Samaritan Episcopal ChurchGood Shepherd Episcopal ChurchGrace Episcopal ChurchHālau Wa‘a EpicopalHoly ApostlesHoly CrossHoly InnocentsHoly Nativity‘Iolani SchoolSeabury HallSt. Andrew, Cathedral ofSt. Andrew's SchoolsSt. Augustine'sSt. ChristopherSt. ClementSt. Elizabeth'sSt. James'St. John the BaptistSt. John's (Kula)St. John's By-the-SeaSt. Jude'sSt. Luke'sSt. Mark'sSt. Mary'sSt. Matthew'sSt. Michael and All AngelsSt. Paul'sSt. Peter'sSt. Stephen'sSt. Timothy'sThe Episcopal Church in Hawai‘iTrinity By-the-SeaWest Kaua‘iOther
I am signing this*

for myself as an adultas the parent or legal guardian of a minor
Name of person signing the form*

First NameLast Name
Name of minor*

First NameLast Name
Signature*

Clear
Date SIgned*

MonthDayYear
Date
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