Diocesan Publicity/Promotion Release Form

I hereby grant to the Diocese of Greensburg, Pennsylvania, and its respective licensees, successors and assigns, the right and permission, with respect to those photographs taken of me or the minor named below on whose behalf I am signing, and with respect to any printed or electronic matter in connection therewith, to do the following: 1. To include such photographs on the Diocese of Greensburg website, social media sites, parish website, and parish social media. 2. To use my name, or the name of the minor on whose behalf I am signing, in connection with the foregoing. I hereby release, discharge and agree to indemnify and hold harmless the Diocese of Greensburg and its legal representatives, licensees, successor and assigns, from all claims and demands whatsoever arising out of or in connection with the foregoing, and waive any right to inspect or approve the same.(Required)

This waiver is for:(Required)

Adult Participant

Name(Required)

First Last

Email(Required)

Phone Number(Required)

Adult Participant Signature(Required)

Minor Participant

Child Name(Required)

First Last

Parent/Guardian Name(Required)

First Last

Parent/Guardian Email(Required)

Parent/Guardian Phone Number(Required)

Parent/Guardian Signature(Required)

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Diocesan Publicity/Promotion Release Form