Comox Valley Unitarian Fellowship

Photo Release Form

Completing the release form(s)

1. Photos taken may be used for publicity and information purposes such as displays, newsletter, brochures,
annual reports and the website.
2. A separate release form is required for each individual who is recognizable in the photo.

PHOTO RELEASE
As a contribution to our religion’s publicity efforts, I hereby give my consent to, and authorization for, the use and reproduction by the Canadian Unitarian Council* (CUC) and The Comox Valley Unitarian Fellowship (CVUF) of any and all photographs which have been taken of me for publicity and information purposes, including but not limited to, displays, newsletters, brochures, annual reports and the website. This consent shall remain in effect until such time as I provide CUC and/or CVUF with written and dated notice of withdrawal of my consent. All digital images, negatives, positives and prints shall be the property of the CUC and/or CVUF.

Date:
MM slash DD slash YYYY
Name:
First Last
Address:
Street Address Address Line 2 City Province Postal Code
Are you 19 years of age or older?
- Yes
- No
I consent to the use of any photographs by the Fellowship
- Yes
- No
If under 19 years of age, consent must be given by a parent or guardian:
Name of Parent / Guardian:
First Last
I hereby certify that I am the parent or guardian of the minor named above.
I consent to the use of any photographs by the Fellowship
- Yes
- No
Captcha

Comox Valley Unitarian Fellowship

Comox Valley Unitarian Fellowship

If under 19 years of age, consent must be given by a parent or guardian:

Comox Valley Unitarian Fellowship

250 Beach Drive, Comox, B.C. V9M 1P9

250 702 9167