Facebook Instagram Flocknote YouTube

Minor Publicity Release Form

- The maximum number of form submissions has been reached. This form is currently not available.
  
  Guardian Legal Name
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Minor Legal Names REQUIRED Please fill out this field.
  
  Name of Minor 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Minor 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Minor 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Minor 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Minor 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Minor 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  I, (full legal name of parent or legal guardian above), on behalf of and as the parent or legal guardian of the following person, who is under eighteen (18) years of age, (print full legal name of minor above) (hereinafter "the Minor(s)"), hereby authorize St. Andrew the Apostle Roman Catholic Church of the Diocese of Phoenix to record the Minor(s)'s picture, voice and physical likeness in photographs, films, video, or other media in connection with the preparation and production of various video, print, and web-based materials to be prepared by or for St. Andrew the Apostle Catholic Church of the Diocese of Phoenix, and further, to use the Minor(s)'s picture, voice, physical likeness or silhouette in connection with the unlimited distribution, advertising, promotion, exhibition or other use of such materials by any method or device, in any media or publication, or in connection with brochures, the Parish websites, social media platforms, the Parish bulletin, or any other media or publication, without further compensation or permission. I understand that St. Andrew the Apostle Catholic Church of the Diocese of Phoenix exclusively owns all rights to these recordings and materials irrespective of the form in which they are produced or used.
  
  I further agree, on behalf of myself and the Minor(s), to release from liability and hold St. Andrew the Apostle Roman Catholic Church of the Diocese of Phoenix and all of their affiliated organizations and entities, and their licensees, employees and agents harmless from and against any and all claims and liability for damages, losses or expenses of any kind arising from the making of such recordings and their use, including, without limitation, any claims with respect to the Minor(s)'s privacy or publicity.
  
  I have read and understand the contents hereof, and have the right and authority to execute this release and to give this release and right of defense and indemnification on behalf of the Minor(s). I understand that this Liability /Publicity Release is to be interpreted under the laws of the state of Arizona without resort to its conflict of laws rules, and I hereby submit to the jurisdiction of the courts of the state of Arizona with respect to any action arising under this Release.
  
  Parent/Guardian Consent
  I am the parent or legal guardian of the Minor(s) named (listed above) I have the legal right to consent to and do consent to the terms and conditions of this Release.
  
  I Agree Please select this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Submit
  
  This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.