2018-2019 Media Release Form

Thank you for registering your child/children for the Saint Raphael Parish School of Religion!  Below you will find the media release form for the 2018-2019 school year.  Please fill out the form and submit it online.  You may contact the parish office if you have any questions.  

2018-2019 PSR Media Release
Saint Raphael Parish Consent and Release of Liability For Use of Minor's Likeness and Other Information I(We) the parent(s) and or guardian(s) hereby grant consent for Saint Raphael ("Parish") and/or its agents to record (in writing or otherwise), photograph, audiotape, or videotape the name, image, likeness, spoken words, student work, and/or performance of my minor child/children listed below, in any form, and to display, release, exhibit, publish, or distribute the same, or any part thereof, for the purpose of and in connection with any material that may be created by or on behalf of the Parish (including the Parish's school) including, without limitation, Parish bulletin boards, school yearbooks, the Parish's or Parish's school website, print and electronic media; Parish and Parish school marketing, public relations and communications materials and/or presentations, and such other uses as may not be contemplated herein, without further notice or compensation as follows: I further understand that by entering into this informed consent and release, and by granting permission as stated herein, I herby release the Parish, the Parish School, the Diocese of Cleveland, and their respective officers, directors, agents and/or employees from and against any and all liability, loss, damage, costs, claims, and/or causes of action arising out of or related to the above items to which I have consented. I further understand that the Parish and its respective officers, directors, agents and/or employees have no control over use of photographs, videotapes, audiotapes, or other records made by others and/or outside the scope of this consent and release. Finally, in signing below I acknowledge that all recordings, audiotape, videotape, photographic proofs, photographic negatives, positives, and prints shall constitute the property of the Parish.
Name of Minor Student 1
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Name of Minor Student 2
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Name of Minor Student 3
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Name of Minor Student 4
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Consent and Release
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Parent Consent Statement “By typing my name below, which shall constitute my electronic signature, I acknowledge that I am the parent or legal guardian of the above named Child(ren) and have the authority to sign this document and act on his/her or their behalf. I agree that my electronic signature is intended to authenticate this writing and to have the same force and effect as my manual signature. As the parent or legal guardian of the student(s) listed above, my signature constitutes my acknowledgement and agreement to all of the foregoing terms.” :
Parent Consent Signature
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Spam Capture
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