MEDIA RELEASE FORM
Assumption BVM Parish
During the course of the year we will be taking photographs, videotaping, and/or voice taping individuals.*
This form allows you an opportunity to indicate if you do not want your child photographed, videotaped, and/or voice taped at various activities within the parish or on group outings outside of the parish.
I, ____________________________ do not want my child (children) photographed,
(parents name)
videotaped, and/or voice taped at various functions within the classroom, parish activities, or at parish sponsored outings.
Parent/Guardian Signature: ___________________________________
Student Name(s): ________________________________
________________________________
________________________________
________________________________
________________________________
Date: ________________
(This consent must be re-examined and signed each year)
This should be filled out and returned to the Faith Formation Office by________
Only if you do not want your child photographed, videotaped, and/or voice taped.
* Pictures are usually used on our parish bulletin boards. There may be times, however, when a picture might be used in the Catholic Weekly, posted on the website, in the bulletin, or in a parish brochure.