Minor Media Release Form

* Indicates required field

Guardian Name *

First

Last

Guardian email *

If you have more than one child, you can submit additional forms after completing the first. To accomplish this, please refresh this page after receiving the your confirmation message of the first submission.

Minor Name *

First

Last

Age at time of submitting this form *

Relationship to Minor *

I give the St Timothy's Episcopal Church permission to take photographs, video, and/or record the voice of the minor named in this form, so that St. Timothy's may use these images and/or audio in print and online publications. I give this consent with the knowledge that St. Timothy's is following the Diocese of California's latest policies regarding digital and social media.

When you select the "submit release" button below, it will serve as your electronic signature. This submission is automatically dated when you send.
Please contact the office if you have any questions: [email protected]

Submit Release

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