*** Please complete this form, including the names of ALL registered children and return with your registration. The Diocese requires us to have this form on file each year your child is registered in our program.
Office of Evangelization and Catechesis
Roman
Catholic Diocese of
Church
of Christ the King,
Name & City, State of Parish/Institution
PERMISSION FOR PHOTOGRAPHS/VIDEO TAPES/FILMS
I hereby authorize and give my consent for the taking of pictures (moving or still) of
__________________________________________and further give my permission for their
reproduction for:
1. Teaching purposes only
2. News release
3. Publication
4. Community awareness programs
____________________________ _____________________________________________________
date
signature
relationship____________________________
This space may be used to state any restrictions you may have on the above.
10/25/2006