Please complete this form to confirm your agreement with the following statement: "I hereby give permission for images of my child, captured during Cross Culture Church Events/Camps/Activities through video, photo and digital camera, to be used for the purposes of Cross Culture Church promotional material and publications, and waive any rights of compensation or ownership.

Student Name

First Name

Last Name

Student Grade

Parent/Guardian Name

Todays Date

YYYY

Parent/Guardian E Signature