901 East 78th Street, Minneapolis, MN 55420-1300 (800) 745-2202 • Release I hereby grant to the Evangelical Free Church of America (EFCA) and to its employees, agents and assigns the right to photograph me or my dependent and use the photo and or other digital reproduction of him/her or other reproduction of his/her physical likeness for publication processes, whether electronic, print, digital or electronic publishing via the Internet. Model's Signature: Model's Printed Name: Address: Date: For children: I certify that I am a custodial parent and have the aforementioned rights to assign. Signature of Parent or Guardian: Print Name of Parent or Guardian: Address: Date: Please send to:
901 East 78th Street, Minneapolis, MN 55420-1300 (800) 745-2202 • Release I hereby grant to the Evangelical Free Church of America (EFCA) and to its employees, agents and assigns the right to photograph me or my dependent and use the photo and or other digital reproduction of him/her or other reproduction of his/her physical likeness for publication processes, whether electronic, print, digital or electronic publishing via the Internet. Model's Signature: Model's Printed Name: Address: Date: For children: I certify that I am a custodial parent and have the aforementioned rights to assign. Signature of Parent or Guardian: Print Name of Parent or Guardian: Address: Date: Please send to:
staten_island_team_leader_0316.docx