Media Permission

Please fill out this form and click submit.

Name

This address will receive a confirmation email

Phone

INTERNAL: MEMBERSHIP DIRECTORY APP

Media Permission Applies To:

Please select one option.

JUST ME MY WHOLE FAMILY

If my whole family, who in the family does this apply(specify):

I give permission to be listed in the membership directory app.

Please select one option.

Yes No

SOCIAL MEDIA COMMUNICATIONS

With regard to the use of my image, picture, or likeness in the newsletter, on the website, on social media, in worship slides, in communications of the church, and being identified by name:

Please select one option.

I GIVE PERMISSION IDENTIFIED BY FIRST NAME AND LAST INITIAL I GIVE PERMISSION WITHOUT BEING IDENTIFIED BY NAME I DO NOT GIVE PERMISSION FOR MY IMAGE, PICTURE, OR LIKENESS TO BE USED

INTERNAL: NEWSLETTER/WEEKLY CONNECT/PRAYER REQUESTS

With regard to the use of my full name and birthday (no year) in the church newsletter

Please select one option.

I GIVE PERMISSION FOR MY FULL NAME AND BIRTHDAY (NO YEAR) TO BE USED I GIVE PERMISSION FOR MY FULL NAME TO BE USED, BUT DO NOT WANT MY BIRTHDAY PUBLISHED I DO NOT GIVE PERMISSION FOR MY FULL NAME OR BIRTHDAY TO BE USED

Age

In the Age field above tell us your birthday month and day and enter 0000 for the year. Doing so will only show your month and day.
Format: MM/DD/0000

COMMUNICATIONS

Weekly Connect

Please select one option.

Yes No

Newsletter

Please select one option.

By Mail By Email Receive Both by Mail and Email NA

Approval

By checking this box you are approving the selections you have made.

Please select all that apply.

Approval of selections

NOTE: If you ever wish to have your data removed from our database, please submit that request in writing to the office. Additionally, if your circumstances change, please fill out a new form and submit it.

PLEASE SELECT THE SUBMIT FORM BUTON TO HAVE YOUR ANSWERS RECORDED

Description

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Media Permission

Description

Please Fix the Following