BRUNSWICK ISLANDS BAPTIST CHURCH

BRUNSWICK ISLANDS BAPTIST CHURCH
PHOTO RELEASE WAIVER
This Agreement is executed by and between the following:
Name of Parent/Guardian
Name of Child
Name of Child
Name of Child
The Releasor hereby grants, and voluntarily authorizes in his capacity with full
understanding, to Releasee, the use of the following photographs:
Purpose of Release of Photograph(s)
Use of my image for video photography involving Church activities.Use of my name or other personal information with my consent and image in printed publications of Church.Use of my name or other personal information with my consent and image in electronic publications of Church.Use of my name or other personal information with my consent and image for online publications of the Church, in the website and social media accounts.
Age of Consent
I affirm that I am of legal age and that I am signing this agreement with full consent, with the knowledge of my rights and obligations to this agreement.I affirm that I am the legal parent/guardian of the minor child subject in the released photograph(s) and I am signing this agreement on behalf of the minor child.
Dispute Resolution
In case of dispute arising from this Agreement, including but not limited to, breach of this Agreement, the parties agree to address the concern in mutually acceptable alternative dispute resolution process mutually agreed upon by the parties. In case no agreement shall be made upon the mode of dispute resolution process, the matter shall be submitted to arbitration proceeding for final resolution.
Signature of Parent/Guardian of Releasor
Clear
Name
First NameMiddle NameLast Name
Date SIgned
MonthDayYear
Date
1672 Mt Pisgah Rd SW, Supply, NC 28462 Phone: (910) 842-8969
http://brunswickislandsbaptist.com/
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BRUNSWICK ISLANDS BAPTIST CHURCH

1672 Mt Pisgah Rd SW, Supply, NC 28462 Phone: (910) 842-8969