Photo Release Form - Danville Church & Community Tutorial Program

Parent/Guardian Name*
First Name Last Name
Child/Student Name*
First Name Last Name
As a participant in the Danville Church-Based Tutorial Program, I give my permission for photographs taken of my child in connection with any Church- Based Tutorial activity.

I give permission for such photographs to be used for any lawful purpose, including for example such purposes as publicity, illustration, advertising, newspaper articles and web content, ect. I have read and understand the above:
Signature, parent or guardian (if child is under 18 year of age)
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date
Date Format: MM slash DD slash YYYY