Consent and Release Form – Photography & Video Imagery Participant's Name(Required) First Last Phone(Required)Email(Required) Participant is under 18 years old Yes No Consent(Required) I hereby grant to the Diocese of San José and its employees, agents, licensees and legal representatives, the right to take photographs or videos of me in connection with my participation in the event mentioned below at the location mentioned below. I also authorize the Diocese of San José to use any such pictures or videos of me with or without my name for any lawful purposes including, but not limited to, purposes of publicity, illustration, advertising and/or web content. I hereby waive any present or future right to inspect or approve of any published image or videos that may be created or distributed in connection herewith. I understand and agree that any photograph or video using my likeness will become the sole property of Diocese of San José and will not be returned to me. I also understand and agree that since my participation is voluntary, I will not receive any financial compensation. I hereby hold harmless and release and forever discharge the Diocese of San José and its employees, agents, licensees and legal representatives from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators or any other person(s) acting on my behalf or on behalf of my estate have or may have by reason of my authorization, consent and release herein. I have read this entire Consent and Release Form, I fully understand it, and I agree to be bound by its terms. I represent and certify that I am at least eighteen (18) years old, or if not on this date that my Parent/Legal Guardian has also executed this Form.Location of Event:(Required) Name of Event:(Required) Event Date(Required) Event Contact Name(Required)Event Contact Email PARENT CONSENT AND CONTACT INFORMATIONPlease complete the parent consent and contact informatio below. Parent/Guardian Relationship (ex. Mother, Father)Parent/Guardian NameParent/Guardian EmailParent/Guardian PhoneType your name below as your electronic signature for your release and consent.(Required)Date of Consent(Required)
