Photograph, Video, Voice and Publicity Release Form

I/We,Click here to enter name of adult(s), give my permission to Messiah Lutheran Church (MLC) to use my/our name(s), likeness, image, voice, and/or appearance as such may be embodied in any pictures, photos, video recordings, audio recordings, audiotapes, digital images, and the like, taken or made on behalf of MLC and its ministry. I/We agree that MLC has complete ownership of such pictures, etc., including the entire copyright, and may use them for any purpose consistent with the MLC mission. These uses include, but are not limited to illustrations, bulletins, videotapes, reprints, reproductions, publications, advertisements, and any promotional or educational materials in any medium now known or later developed, including the Internet - specifically the church website, Podcasts, webinars, and Facebook page. I/We acknowledge that I/We will not receive any compensation, etc for the use of such pictures, etc., and hereby release MLC and its agents and assigns from any and all claims which arise out of or are in any way connected with such use.

I/We have read and understood this consent and release. I/We understand that I/we have the right to revoke this consent at any time, provided my/our revocation is in writing.

Names of any minor under 18 years of age:

Printed Name: Click here to print name of person participating.

Printed Name: Click here to print name of person participating.

Printed Name: Click here to print name of person participating.

Printed Name: Click here to print name of person participating.

Printed Name: Click here to print name of person participating.

I/We give my/our consent to MLC to use my/our name(s) and/or any minor children’s namesor likeness to promote the church, its ministries, and/or programs events, and activities. Typing in my/our name(s) and date below is my/our electronic signature of authorization.

Print Name as Signature of AuthorizationClick here to print name.

Date Click to enter date.

Print Name as Signature of AuthorizationClick here to print name.

Date Click to enter date.

Messiah Lutheran Church, 122 W. 7th St. Grand Island, NE 68801