Name of Person Giving Media Consent*If you are filling out this form for your child (under 18), please give the child's name. First Last I give my consent to utilize any photographs or images of myself, as well as the sound of my voice from any audio or video, to be used by the Diocese of St. Petersburg, or any parishes, schools or entities within the Diocese of St. Petersburg. Such use is given liberally, for any form of media publication, including any form of social media. I waive any rights I might have to inspect and approve the finished product or its use, and further waive any claim for any compensation associated with said use.* Yes, I understand and agree. No, I do not agree. I acknowledge that I am* of legal age and have the full capacity to execute this consent the parent of the minor and am signing as the legal guardian on behalf of the above individual. Signature* Reset signature Signature locked. Reset to sign again Parent or Guardian Name* First Last Parent or Guardian Signature* Reset signature Signature locked. Reset to sign again Date of Signature* MM slash DD slash YYYY
