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Hope Church of Pocahontas County SOCIAL MEDIA/NEWSLETTER Release Form
Hope United Methodist Church of Pocahontas County requires student and parent permission to use a person’s photograph, voice, and/or name in various media projects Please answer each section below. When you submit, it will record your response.
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* Indicates required question
FOR CHILDREN UNDER 18 living in your home:
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NA - - There are currently no children under 18 living in my/our home. (please type NA in the following question below)
Yes, I consent. I grant permission for my child/children to participate and appear in video or audio recordings, films, photographs, written articles, or on websites and social media.
No, I do not consent. I do not grant permission for the use of my child’s photograph, voice, and/or name in various media projects.
Names (first & last) of all children the above applies to:
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Your answer
FOR MEMBERS/FRIENDS OF HOPE: Pictures
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Yes, I consent. I grant permission for my picture to appear in video or audio recording, films, photographs, written articles, or on websites and social media.
No, I do not consent. I do not grant permission for my picture to appear in video or audio recordings, films, photographs, written articles, or on websites and social media.
FOR MEMBERS/FRIENDS OF HOPE: Birthdays &/or Anniversary
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Yes, I consent. I grant permission for my birthday &/or anniversary (month & day) to appear in video or audio recordings, films, photographs, written articles or on websites and social media.
No, I do not consent. I do not grant permission for my birthday &/or anniversary (month & day) to appear in video or audio recordings, films, photographs, written artiles or on websites and social media.
If YES (consent) for Birthdays &/or Anniversaries, BIRTHDAY Month/ Day & first person's name
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Your answer
If YES (consent) for Birthdays &/or Anniversaries, BIRTHDAY Month/ Day & second person's name (If none, put NA)
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Your answer
If YES (consent) for Birthdays &/or Anniversaries, BIRTHDAY Month/ Day & list additional people's name (if none, put NA)
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Your answer
If YES (consent) for Birthdays &/or Anniversaries, list your ANNIVERSARY Month & Day
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Your answer
Name of person completing permission form:
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Your answer
Email Address:
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Your answer
Mailing Address: (street/city/zip code)
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Your answer
Phone number - Land line: (if none, type NA)
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Your answer
Phone number - Name & Cell : (if none, type NA)
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Your answer
Phone number - Second Name & Cell : (if none, type NA)
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Your answer
Email address for Second Name: (if none, type NA)
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Your answer
Today's Date:
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