Sample Photo Release Form

Photo Release Form

Devonshire Church

5630 Devonshire Road

Harrisburg, PA 17112

Permission to Use Photograph

Event: Vacation Bible School – Gotta Move!

I grant to Devonshire Church, the right to take photographs of me and

my family in connection with the above-identified event. I authorize

Devonshire Church, its assigns and transferees to copyright, use and

publish the same in print and/or electronically.

I agree that Devonshire Church may use such photographs of me with

or without my name and for any lawful purpose, including for example

such purposes as publicity, illustration, advertising, and Web content.

I have read and understand the above:

Printed name (parents) ___________________ _________________

Signature (parents) ______________________ _________________

Printed name (children) __________________ __________________

__________________ __________________

Address _________________________________________________

Date _____________________________________