MODEL RELEASE FORM For print, web, video, and all other media

I, the model/undersigned, do hereby consent and agree that The Pacific Northwest Conference of the United Methodist Church, its employees, or agents have the right to photograph, videotape, or record audio of me to use in various media, now and hereafter known. Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, video, images, or audio recordings of me for materials including, but not be limited to, printed materials such as brochures and newsletters, promotional videos, and digital images such as those on a web site. I further consent that my name and identity may be revealed therein or by descriptive text or commentary. I do hereby release to The Pacific Northwest Conference of the United Methodist Church, its agents, and employees all rights to exhibit this work in electronic and print form publicly or privately and to market and sell copies. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used. I understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmission or playback. I also understand that The Pacific Northwest Conference of the United Methodist Church is not responsible for any expense or liability incurred as a result of my participation in this recording, including medical expenses due to any sickness or injury incurred as a result. I have read and understand the foregoing statement, and am competent to execute this agreement.

Model’s Name

Date Address

Phone

Model’s Signature

(If the person signing is under age 18, a parent or legal guardian must sign below.) I hereby certify that I am the parent or legal guardian of the model named above and I give my consent without reservation to the foregoing on behalf of him or her.

Parent/Guardian Signature Date