Photo Release Form

Student Name(Required)

First Last

Student Name

First Last

Student Name

First Last

Parent / Guardian Name(Required)

First Last

Parent / Guardian Name

First Last

Address(Required)

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

Second Address (if applicable)

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

Phone(Required)

Alternate Phone

Consent(Required)

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(Required)

Signature of Second Parent or Guardian

Date(Required)