Photo Permission Form

"*" indicates required fields

I hereby grant to First Presbyterian Church (U. S. A.) of Rocky Mount, North Carolina, and to its members, officers, pastors, representatives and employees (collectively, the “Church”), the unrestricted right to use and publish photographs or other images of me, my spouse, and/or my children (including, without limitation, any photographs in which me, my spouse and/or any of my children are readily identifiable) in any print, electronic, digital, internet or other media; and to alter the same without restriction. I (we) assign such photographs’ and images’ rights and uses to the Church into perpetuity; provided, however, the Church’s right to use and publish photographs pursuant to this permission form shall be deemed terminated if and when I provide written notice to the church that the permission granted under this form has been rescinded. Upon receipt of such notice, the church agrees to promptly remove any applicable photographs from the website.

I hereby release the Church and its legal representatives and assigns from all claims and liabilities relating to said photographs and images.

Name of Minor
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My Address*
MM slash DD slash YYYY
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