Name(Required) First Last Birthdate(Required) MM slash DD slash YYYY Would you like to add a child/ward?NoYesChild/Ward Name(Required) First Last Child/Ward Birthdate(Required) MM slash DD slash YYYY Would you like to add another child/ward?NoYesChild/Ward Name(Required) First Last Child/Ward Birthdate(Required) MM slash DD slash YYYY Image ReleaseI hereby grant the Diocese of Orlando (“Diocese”), Catholic Charities of Central Florida (“CCCF”), and their affiliated entities all rights, title and interest in, and to, the use of my image or likeness, including, but not limited to, all videotape recordings (which may include audio recording), photographs, or audio recordings of, or made by, me (“the Property”) for any lawful purpose whatsoever, including but not limited to use in any Diocese or CCCF publication or on the Diocese or CCCF websites, without attribution, payment or any other consideration. I hereby waive any right that I may have to inspect and/or approve the Property or the copy that may be used in connection therewith, wherein my likeness appears, or the use to which it may be applied. On behalf of myself, my heirs, representatives, executors, and assigns, I hereby release, discharge, and agree to indemnify and hold harmless the Diocese and CCCF and each of their agents, officers, volunteers, employees and affiliated entities from all claims, demands, and causes of action that I have or may have by reason of this authorization, including any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur in relation to the Property. I hereby irrevocably authorize the Diocese and CCCF to edit and revise as necessary, copy, display, publish, or distribute the Property for any lawful purpose including combining them in composite work, such as collages (with or without additional graphic designs), or other edited materials for publicity, advertising, and Internet content. In addition, I waive any right to inspect or approve the finished Property, in which my image or likeness appears. I agreeStatement ReleaseI hereby grant the Diocese of Orlando (“Diocese”), Catholic Charities of Central Florida (“CCCF”), and their affiliated entities permission to use quoted statements by me (“the Product”), in whole or in part, including but not limited to use in any Diocese or CCCF publication or on the Diocese or CCCF websites, without attribution, payment or any other consideration. I hereby waive any right that I may have to inspect and/or approve the Product, where the Product appears, or the use to which it may be applied. On behalf of myself, my heirs, representatives, executors, and assigns, I hereby release, discharge, and agree to indemnify and hold harmless the Diocese and CCCF and their agents, officers, volunteers, employees and affiliated entities from all claims, demands, and causes of action that I have or may have by reason of this authorization, including any liability by virtue of any altering of the Product’s intended meaning or context, whether intentional or otherwise, that may occur due to the manner, context, or location in which the Product is used. I hereby irrevocably authorize the Diocese and CCCF to edit and revise as necessary, copy, display, publish, or distribute the Product for any lawful purpose including combining them in composite work (with or without additional graphic designs), or other edited materials for publicity, advertising, and Internet content. In addition, I waive any right to inspect or approve the finished Product, in which my statement(s) or voice appears. I agreeConsent(Required) By checking this box and completing this form, I represent that I am eighteen (18) years of age or older, and that I have read and understand the terms of this release.Send Me a Copy If you would like a copy of this consent, please provide your email address.
