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MODEL RELEASE SOUTHERN MISSOURI DISTRICT GIRLS MINISTRIES I, _______________________, do hereby give the Southern Missouri District Girls Ministries Office and its assigns, licensees and legal representatives the irrevocable right to use my name (or any fictional name), picture, portrait, photograph or video and electronic images in all forms and media and in all manners, including composite or distorted representations, for advertising, trade or any other lawful purposes, and I waive any right to inspect or approve the finished product, including written copy, that may be created in connection therewith. I am of full age. I understand that I will not be compensated for my time. I have read this release and am fully familiar with its contents. Witness: ____________________ Print Name:__________________ Address: ____________________ ____________________________
Signed: ___________________ Print Name: _______________ Address: __________________ Phone:____________________ Date: _____________________
CONSENT (if applicable) I am the parent/guardian of the minor named above and have the legal authority to execute the above release. I approve the foregoing and waive any rights in the premises. Witness: ______________________ Print Name: ___________________ Address: ______________________ ______________________________
Signed: ___________________ Print Name:________________ Address: __________________ Phone: ____________________ Date: _____________________
Our intent is to use the pictures in our District Publications, videos and possibly power points to show other young ladies what retreat is all about. We will not sell these to anyone. Any that would be on the Internet would be adjusted so as not to identify any single individual. Thank you for your consideration of this matter.
