ADULT PHOTO AND VIDEO RELEASE FORM
Date: October 6, 2019

Location: Our Lady of the Lake Catholic Church, Mound, MN

I hereby consent to and authorize the use and reproduction, in print or electronic format by Our Lady of the Lake Catholic Church and the Archdiocese of Saint Paul and Minneapolis or anyone authorized by the Archdiocese of Saint Paul and Minneapolis, of any and all photographs, film, video, electronic images (“images”) or other likeness which have been taken on this day for any advertising, commercial or publicity purpose, without compensation, including sharing those images or likeness with commercial sponsors, news, commercial publications, broadcast producers, or community organizations and allowing the commercial sponsors, news, commercial publication, broadcast producers or community organization to publish the same. I further agree that Our Lady of the Lake Catholic Church and the Archdiocese of Saint Paul and Minneapolis are not liable for any damages or injuries resulting from such use. All images: electronic; negatives and positives; and prints, are owned by Our Lady of the Lake Catholic Church and/or the Archdiocese of Saint Paul and Minneapolis.

I also consent to the use of my name in connection with photographs of me taken the above-mentioned days, and understand that images may be combined with other images, text, and graphics, and cropped, altered or modified.

I hereby acknowledge that I am 18 years of age or older and have read and understood the terms of this release.

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Address
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PHOTO AND VIDEO RELEASE FORM
Our Lady of the Lake Catholic Church
2385 Commerce Blvd
Mound, MN 55364
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