Photo, Audio and Video Release Form

During the 2007-2008 school year, St. Rose & St. Mary’s Youth Ministry/RE Program may reproduce or participate in videotape, motion picture, audio recording, web posting or still photograph productions that involve the use of students' names, likenesses or voices. Such productions may be used for educational or exhibition purposes by St. Rose & St. Mary’s Youth Ministry/RE Program and may be copied, copyrighted, edited and distributed by St. Rose or St. Mary’s Catholic School/RE Program.

News media, including representatives of television, radio, newspapers and magazines, also may be permitted on school/parish property and may take notes, still photos, sound recordings and/or moving pictures that may include your child. These items may appear or be used in news or feature stories by print, television, website posting or radio media.

If permission is granted to use your child’s photograph/audio recording/video recording, please complete the permission slip below and returning it to the administrator of your Youth Ministry/RE program. If you have any questions, please direct them to Lori Peterson.

I, ___________________________________________, the undersigned, do hereby give (Please Print)

permission to the St. Rose & St. Mary Youth Ministry/RE Program to use the

(Check ALL that apply)

_____ Name              _____ Picture               _____ Voice               _____ Other likenesses

of my child(ren) for the website and promotional activities. This request is valid for

the current Youth Ministry/RE program until October 2007.

Student's Name        Grade

________________________________________ _______________________

________________________________________ _______________________

________________________________________ _______________________

Signature: Parent(s)/Guardian ___________________________________________________

Date: _____________________________