Diocese of Ogdensburg

The Roman Catholic Church in Northern New York

I, (Parent/Guardian Full Name) (*)
Invalid Input

hereby consent to and authorize the use and reproduction by the Roman Catholic Diocese of Ogdensburg ("Diocese"), its legal representatives, licensees, successors and assigns, those for whom the Diocese is acting, and those acting with its authority and permission (collectively, the "Authorized Parties"), of any and all photographs, digital images, videotapes or recordings made of
Child's Full Name(*)
Invalid Input

who is my minor child, for use by the Roman Catholic Diocese of Ogdensburg, its employees, officers and agents, and the right to copyright and/or use, reuse and/or publish, republish photographic pictures, digital images, videotapes or recordings in conjunction with my name.

I, on behalf of myself and on behalf of my minor child, also give permission for the photographs, digital images, videotapes, or recordings to be used in their entirety and/or edited versions as deemed necessary by the Roman Catholic Diocese of Ogdensburg including the use of images on printed publications or materials, posters, brochures, greeting cards, calendars, electronic publications, or Web sites. I represent and warrant that any photographs, digital images, videotapes, or recordings submitted by me or on my behalf to the Diocese do not in any way infringe on the proprietary rights of any third party, including but not limited to copyright or trademark.

Furthermore, permission is also given for the photographs, digital images, videotapes, or recordings to be used by the Roman Catholic Diocese of Ogdensburg at any time in the future without further clearance from me.

I, on behalf of myself and on behalf of my minor child, hereby release, discharge and agree to save harmless the Roman Catholic Diocese of Ogdensburg and each of the Authorized Parties from any liability, costs or expenses arising by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form whether intentional or otherwise, that may occur or be produced in the taking of the Images or in any subsequent processing thereof, as well as any publication thereof, including without limitation any claims for libel, defamation, invasion of privacy, or breach of publicity or other property rights.

The Roman Catholic Diocese of Ogdensburg will not sell these photographs, digital images, videotapes, or recordings to another company and will only use them for the mission of the church.

The Roman Catholic Diocese of Ogdensburg will not use the minor’s full name or otherwise identify the individual appearing in the photographs, digital images, videotapes, or recordings, unless explicitly permitted by checking the checkbox below.

I hereby affirm that I am over the age of majority and have the right to contract on behalf of myself and my minor child, 1 have read the above authorization, release and agreement, prior to its execution. I fully understand the contents thereof. This agreement shall be binding upon me, my minor child, and heirs, legal representatives and assigns thereof.

If at any point you wish to remove a picture or terminate your release consent form please contact The Roman Catholic Diocese of Ogdensburg. Phone: 315-393-2920 Web: www.rcdony.org
I allow the Roman Catholic Diocese of Ogdensburg to use my child’s full name and otherwise identify them.(*)
Invalid Input

Parent or Guardian Full Name(*)
Invalid Input

By typing your full name in the Parent or Guardian Full Name field above you certify that everything in this form is true and that you understand what is being asked of you.
Email(*)
Invalid Input

Child's Full Name(*)
Invalid Input

Child's Date of Birth(*)
Invalid Input

Address(*)
Invalid Input

Date:(*)
Invalid Input

Ex. mm/dd/yyyy

Verification: Please check the box next to “I’m not a robot” to show that you are a real person
Invalid Input

When you click submit, you will see a thank you page that tells you your submission has been successful