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Photograph/Video/Sound Release Form

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The maximum number of form submissions has been reached. This form is currently not available.

I hereby give St. Catherine of Siena Parish and School permission to use the photograph/video/sound of the minor(s) or myself listed below for their publicity, promotion, news releases, videos, and web use. This may also apply to the written composition or visual art of the minor, or myself if it is published.

St. Catherine of Siena Parish and School agrees that the childs’ name, picture, art, written work, voice, photograph, video or verbal statements shall only be used for public relations, public information, publicity and/or instruction. The parish and school further agrees that children will not be identified by personal details. These details include email or postal addresses, telephone or fax numbers.

Pictures of one to three children are permitted as long as an appropriate release form has been signed by the parent/guardian of each individual shown in the picture. Pictures of four or more children are permitted without a release form and will be printed without first and last names.

No monetary consideration shall be paid. Consent and release have been given without coercion or duress. The photograph, video and sound release is valid for subsequent years.

If the child and/or Parent/Guardian wish to rescind this release they may do so at any time with written notice to St. Catherine parish office.

St. Catherine of Siena Parish has no control of media use of pictures/statements which are taken without our permission.

- Child REQUIRED Please fill out this field.
- Child 1
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Age REQUIRED Please fill out this field. Please enter an integer (number).
- Child 2
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Age REQUIRED Please fill out this field. Please enter an integer (number).
- Child 3
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Age REQUIRED Please fill out this field. Please enter an integer (number).
- Child 4
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Age REQUIRED Please fill out this field. Please enter an integer (number).
- Child 5
  - First Name REQUIRED Please fill out this field. Please enter valid data.
    
    Last Name REQUIRED Please fill out this field. Please enter valid data.
  - Age REQUIRED Please fill out this field. Please enter an integer (number).
Parent/Guardian 1 Name REQUIRED Please fill out this field. Please enter valid data.
Parent/Guardian 2 Name Please enter valid data.
First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
I give permission to St. Catherine of Siena Parish and School to publish the image and/or work of my child/children or myself.
I Agree Please select this field.
Parent/Guardian Signature Please enter valid data.
Date Signed REQUIRED Please fill out this field. Please enter a date.

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