Sy Sylvester Youth Ministry
Personal Information Release Form
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| I hereby grant my consent to use and license the use of my name and photo whether in still or in motion pictures with or without my name, for any editorial, promotional, webpage, or other purpose whatsoever. St. Sylvester Youth Ministry may exercise its rights in any way it sees fit for its production, for advertising, for the web, and for other purposes. | |||
| ___________________________________ _________________________________ | |||
| Signature | Signature of Parent/Guardian if under 18 | ||
| _______________________________________ | |||
| Name (Printed) | |||
| _______________________________________ | |||
| _______________________________________ | |||
| Address | |||
| (_____)_________________________________ | |||
| Telephone number | |||
Witnessed by:__________________________________
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