Fort Detrick Holy Family Catholic Community Council 1776 Ditto Ave

Fort Detrick, MD 21702

PARENTAL CONSENT, PHOTO RELEASE FORM

Effective for one Year from signed date

Please fill out and sign the appropriate statement to either give or to decline permission to use

pictures of your child on the Catholic Community website and/or for other church publicity.

With regard to the use of photos on our website, it is the policy of Fort Detrick Holy Family

Catholic Community Council that children in photos not be identified by name IAW AR 25-1,

AR 25-2 and AR 25-1-1.

Please return this form to the Catholic Community Council Secretary.

(Additional Children please use the back of the form)

___________________________________________________________ ______ _________

Name of Minor Child Age Grade

__________________________________________________________ ______ _________

Name of Minor Child Age Grade

__________________________________________________________ ______ _________

Name of Minor Child Age Grade

__________________________________________________________ ______ _________

Name of Minor Child Age Grade

_________________________________________________________ __________________

Street Address City Zip Code Phone

To GRANT permission to use your child’s pictures:

I, ___________________________________ (Please print your name) GRANT permission for

Fort Detrick Holy Family Catholic Community Council to publish pictures of my children

named above on the Catholic Community’s website or in the Catholic Community’s press

releases, bulletins or other publicity information. I further state that I have the right to give this

permission as I am the child’s parent or legal guardian. I understand that if I give notice to the

Webmaster or to any Council Elected Officers that I object to any particular picture on the

website, it will be removed as soon as possible.

SIGNED: ______________________________________ Dated: _______________

To DECLINE permission to use your child’s pictures:

I, _____________________________ (Please print your name) DECLINE to grant permission

for to publish pictures of my children named above on the Catholic Community’s website or in

the Catholic Community’s press releases, bulletins or other publicity information. I further state

that I have the right to decline to give this permission as I am the child’s parent or legal guardian.

SIGNED: ____________________________________ Dated: ________________