PARENT/GUARDIAN RELEASE FOR STUDENT OR MINOR (NONCOMMERCIAL) 

  This section to be completed by the Archdiocesan entity (school/parish/ACC) sponsoring the activity (“Location”):   Name of Location: ________________________________________________________________________________________  

 The Location intends to use your child’s image, name, voice and/or work for noncommercial purposes relating to the event(s) or activity(ies) identified below.   Description of events/activities to which this Release applies:  ______________________________________________________________________________________________________________  ______________________________________________________________________________________________________________ 

 Duration of Release: _______________________________________________________________________________     

   This section to be completed by Parent/Guardian:  

 I, __________________________________________________________________________ am the parent/guardian of  _________________________________________________________ , a minor.  

 I hereby authorize the Location to use the following personal information about my child:   (Please initial the applicable boxes)   

 Image:  yes    no    Voice:   yes    no     Name:  yes    no     Work:  yes     no  

 I understand and agree that my child’s image, voice, name and/or work (“Personal Information”) relating to the events or activities described above will be used for noncommercial purposes, including, but not limited to, publicity, exhibits, electronic media broadcasts or research. I understand and agree that my child’s Personal Information may be copied, edited and distributed by the Location in publications, catalogues, brochures, books, yearbooks, magazines, exhibits, films, videotapes, CDs, DVDs, email messages, websites, or any other form now known or later developed (“Materials”).    The Location may use the Personal Information at its sole discretion, with or without my child’s name or with a fictitious name, and with accurate or fictitious biographical material. The Location will not use the Personal Information for improper purposes or in a manner inconsistent with the teachings of the Roman Catholic Church.  

 I waive any right to inspect or approve any Materials that may be created using the Personal Information now and in the future. In exchange for the opportunity given to my child by the Location to participate in the activity, I agree that neither I, nor my child, will receive monetary compensation, royalties or credit. I understand and agree that the Location shall be the owner of all right, title and interest, including copyright, in the photographs, electronic recordings and Materials. If the Location intends to use the Materials for a commercial purpose, I will be provided at that time with information about the terms of the commercial use.  

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I hereby waive, release and forever discharge any and all claims, demands, or causes of action against the Location and its affiliated entities, employees, agents, contractors and any other person, organization, or entity assisting them with the photography, electronic recording or Materials, for damages or injuries in any way related to, or arising from the photography, electronic recording or Materials, or the use of the Personal Information, and I expressly assume the risk of any resulting injury or damage.      I further understand and agree that this Authorization remains in effect until it is withdrawn in writing. I understand that if I change my mind about this Authorization, that I will submit another, new authorization form to the Location. However, my new authorization will not have the effect of revoking this Authorization, and the Location will have no duty or obligation to make any changes or alterations to any Materials that may have been prepared based on this Authorization.    I represent that I have read this Authorization, understand the contents and am able to grant the rights and waivers it contains. I understand that the terms of this Authorization are contractual and not mere recitals. I am signing this document freely and voluntarily.    Signature: _________________________________________________________   Date: ________________________________  

 Print Name: ___________________________________________   Relationship to Child: __________________________ 

 Address: ___________________________________________________________________________________________________    Telephone: ___________________________   Cellphone: _____________________________ 

 Email: ______________________________________________________________________________________________________  

 Name of Child: ______________________________________________________________ Age: ________________________  

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