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PHOTOGRAPH/VIDEO/AUDIO/MEDIA CONSENT & RELEASE FORM

I hereby consent to and authorize Congregation of Christ the King Roman Catholic Church of the Diocese of Baton Rouge (a/k/a Christ the King Parish & Student Center, “Christ the King”), and all entities, representatives, employees and agents operating in connection with it or under its authority (its “Affiliates”), without any compensation due to me therefor, to record, use, edit, reproduce and/or publish photographs, audio, video and/or other electronic images (“Materials”) that may portray and/or relate to me, my image, likeness and/or voice.

I understand that any and all such Materials may be used in various print and electronic media, including but not limited to Christ the King’s website and its publications or for other endeavors related to Christ the King’s interests. I acknowledge and agree that Christ the King may use and/or publish Materials relating to me and/or use my name, photograph, voice, video images and other media relating to me in any manner that it deems appropriate in its sole discretion in order to promote and/or publicize its programs or for any other lawful purpose. Christ the King is under no obligation to identify or otherwise credit me for the use of my name, voice, image, likeness and other media relating to me.

This authorization shall not expire and will remain effective unless and until rescinded in a writing to that effect signed by me and which is notarized and delivered to an officer of Christ the King at 11 Fraternity Lane, Baton Rouge, LA 70803. I hereby release and agree to indemnify, hold harmless and defend Christ the King and each of its Affiliates from all liabilities, damages, losses, claims, demands, causes of action, costs and expenses (including without limitation reasonable attorneys’ fees and court costs) of any nature whatsoever which I, my heirs or any other person acting on my behalf or on behalf of my estate have or may have relating to, arising from or connected in any way to the Materials or by reason of any action to which this authorization applies.
I certify that I am at least 18 years of age as of the date of my signing electronically below:

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