Sample Photo and Video Permission Form
CONGREGATION’S NAME Media Release Form
We often take photographs and videos of adults, youth, and children as they participate in congregational events such as worship, religious education programming, social events, and justice events. We use these images to promote our congregation and our faith in print, on the Web, and on social media.
By signing this form, you authorize the use of your image in these photographs and video recordings, as described below. (Note that providing us an image or recording constitutes your agreement to the Congregation General Usage section without your needing to also sign this form.)
No names nor other identifying personal information about individual children or minor youth will be published without your explicitly stated permission to do so in each individual case.
Names of minors (children or youth under 18) covered by this agreement: _____________________
Please check all that apply:
Unitarian Universalist Usage
___ I hereby authorize Congregation Name to grant permission to other UU groups, such as the Unitarian Universalist Association, Unitarian Universalist Service Committee, and UUA member congregations, to make use of the congregation’s media that includes me and any minors listed here.
Congregational General Usage
___ In consideration of the benefits I receive from my association with Congregation Name, I hereby authorize Congregation Name to make use of my likeness and voice (and that of any minors listed here) in photographs, videos, or audio recordings on their website, in their social media, in their online photo albums and video channels, and in print. This grant is final and on-going, without any additional restrictions or limitations.
Congregational General Usage with Restrictions
___ I grant Congregation Name permission to do the above, with these additional terms and conditions:
Congregational Internal Usage Only
___ I do not authorize Congregation Name to make use of my likeness (and that of any minors listed here) in photographs, videos, or audio recordings that are shared beyond the walls of the congregation.
Name (printed): ______________________________________________
(must be signed by a parent/guardian of a participant under 18 years)