​PARENT’S AUTHORIZATION TO USE CHILD’S IMAGE, NAME, VOICE AND/OR WORK FOR NON-COMMERCIAL PURPOSES 

​​This section to be completed by Saint Genevieve High School 

​Saint Genevieve High School: 

Class/Activity:

​Saint Genevieve High School intends to use your child’s image, name, voice and/or work for the following non-commercial purposes (describe class/activity, date(s) if applicable):

 The following person(s)/entity not connected to Saint Genevieve High School will be involved in the class/activity:

 This section to be completed by Parent/Legal Guardian: I, __________________________________(name), am the parent or legal guardian of ______________________________________(child’s name), a minor. I hereby authorize Saint Genevieve High School to use the following personal information about my child:

 Please initial the applicable boxes

Image/visual likeness:       yes         no 

Voice:          yes        no 

Name:          yes        no 

Work:         yes ​         no

 I understand and agree that my child’s image, name, voice and/or work (the “Personal Information”) will be used for the particular reasons identified above. I further understand and agree that Saint Genevieve High School may use the Personal Information for other non-commercial purposes, including, but not limited to, publicity, exhibits, electronic media broadcasts or research. I understand and agree that the Personal Information of my child may be copied, edited and distributed by Saint Genevieve High School in publications, catalogues, brochures, books, magazines, exhibits, films, videotapes, CDs, DVDs, email messages, websites, or any other form now known or later developed (the “Materials”).

 Saint Genevieve High School 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. Saint Genevieve High School 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. While Saint Genevieve High School will take care to maintain the particular intents and purposes of the photographs or electronic recordings, editing may be necessary to obtain the best results. I release and discharge Saint Genevieve High School and its employees and agents from any liability that may arise out of the making or editing of the photographs or electronic recordings, including but not limited to, distortion, blurring, alteration, optical or auditory illusion or use in composite form. 

In exchange for Saint Genevieve High School’s giving my child an opportunity to participate in the class/activity, I hereby agree that neither I, nor my child, will receive monetary compensation, royalties or credit for use of the photographs or electronic recordings by Saint Genevieve High School. I understand and agree that Saint Genevieve High School shall be the owner of all right, title and interest, including copyright, in the photographs, electronic recordings and Materials. If Saint Genevieve High School 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.

I hereby waive, release and forever discharge any and all claims, demands, or causes of action against Saint Genevieve High School and its 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 Saint Genevieve High School. However, my new authorization will not have the effect of revoking this Authorization, and Saint Genevieve High School 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: ____________________________________ Name of Child: _________________________________________________ Age: _______________________________________​