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Child Name *
Child Name
Parent Name / Emergency Contact *
Parent Name / Emergency Contact
Address *
Address
Phone for Emergency Contact *
Phone for Emergency Contact
MEDIA RELEASE *
By checking the box below and completing this form I consent to the following Media Release for my child: I hereby giver permission to The Christian & Missionary Alliance Church of Sidney, NY to use my photos, image, & likeness in all forms and media for website, print, social media, advertising, portfolio, demo, stock photography, editorial, altering without restrictions, and all other lawful purposes. I understand I am entitled to no compensation. I release the photographer from all forms of claims and liability related to my photo/image/likeness usage.