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ZION CHRISTIAN MINISTRIES INTERNATIONAL

 

Video Consent and Release Form

Without expectation of compensation or other remuneration, now or in the future, I hereby give my consent to Zion Christian Ministries International ( LITTLE LAMBS, BABY LAMBS, LIONS OF JUDAH YOUTH GROUP), It’s affiliates and agents, to use my image and likeness and/or any interview statements from me in it’s publications, advertising or other media activities (including the Internet). This consent includes, but is not limited to: (Initial where applicable)

 

- (a) Permission to interview, film, photograph, tape, or otherwise make a video reproduction of me and/or record my voice;

- (b) Permission to use my name; and

- (c) Permission to use quotes from the interview(s) (or excerpts of such quotes), the film, photograph(s), tape(s) or reproduction(s) of me, and/or recording of my voice, in part or in whole, in its publications, in newspapers, magazines and other print media, on television, radio and electronic media (including the Internet), in theatrical media and/or in mailings for educational and awareness.

This consent is given in perpetuity, and does not require prior approval by me.

Name

Signature

Address

Date

The parental guide signing this documents must be a legal guardian stated on form and gives hereby consents to and gives permission to such minor child.

 

I certify that I have read this consent form in full to the parent/legal guardian whose name appears as stated.

 

Signature of Organizational Representative or Community

ZION CHRISTIAN MINISTRY INTERNATIONAL AND ZIONCONNECT.ORG

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