Media Release Form

Please fill out this form and click submit.
We often take photographs and videos of adults, youth, and children as they participate in congregational events such as worship, religious education programming, social events, and justice events. We use these images to promote our congregation and our faith in print, on the Web, and on social media.
Please consider the following options before filling this form:

Congregational General Usage: In consideration of the benefits I receive from my association with Chalice, I hereby authorize Chalice to make use of my likeness and voice (and that of any minors listed below) in photographs, videos, or audio recordings on their website, in their social media, in their online photo albums, and in print. This grant is final and on-going, without any additional restrictions or limitations.
Unitarian Universalist Usage: I hereby authorize Chalice to grant permission to other UU groups, such as the Unitarian Universalist Association, Unitarian Universalist Service Committee, deBenneville Pines Camp, and UUA member congregations, to make use of the congregation’s media that includes me and any minors listed below.
Congregational General Usage with Restrictions: I grant Chalice permission to do the above, with additional terms and conditions.
Congregational Internal Usage Only: I do not authorize Chalice to make use of my likeness (and that of any minors listed below) in photographs, videos, or audio recordings that are shared beyond the walls of the congregation.

Please select all that apply.
 
 
 
 
 
Please select all that apply.
 
 

Related Documents:
Chalice Media Policy:
81 Image Policy
Photographer’s Covenant: https://www.chaliceuu.org/photographers-covenant/
Printable Media Release Form

Thank you for your contributions and continued participation at Chalice. If you have concerns or questions, our team can be reached at Socialmedia@chaliceuu.org 

*Please note that providing us with an image or recording constitutes your agreement to the Congregation General Usage section without your needing to also sign this form. 
*And you can ask us to take down a specific picture at any time, and we will.

*No names nor other identifying personal information about individual children or minor youth will be published without your explicitly stated permission to do so in each individual case.

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In filling out this Breeze form online, and clicking Submit, you agree and consider this as good as your signature. You are free to change your standing at any time by resubmitting a form.

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