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Image Release

University Heights SDA Church Image Release Form

Comments

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For value received, I hereby consent and authorize the UNIVERSITY HEIGHTS SEVENTH-DAY ADVENTIST CHURCH or its assigns, to use my name and/or the names of my family members who are minors, as listed below, as well as my likeness, photos, videos and other information (or that of family members who are minors) for the purpose of news releases, advertising, publicity, publication or distribution in any manner whatsoever. I further consent to such use in their present form and to any changes, alterations, or additions thereto. I hereby release the UNIVERSITY HEIGHTS SEVENTH-DAY ADVENTIST CHURCH from all liability in connection with all such uses.

Date*

Signed:

Name *

First Last

Signature Required (Checking "Yes" below represents your signature)*

Yes

No

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Additional Minor Family Members to Whom this Release Applies: