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Bethel Lutheran Church

// Video & Photography Informed Consent Form //

I Agree
 - By signing this waiver, I, 
, as a parent or guardian, acknowledge that any photograph or video taken by Bethel Lutheran Church personnel of my child participating in any church related activity becomes the property of Bethel Lutheran Church and may be used for its purposes (church website, children's messages, in-building postings, brochures, social media pages, etc). 

I Agree
- I also acknowledge and consent to Bethel Lutheran church having permission to stream my child's participation in both normal and special Bethel Lutheran Church events such as but not limited to regular weekend services, children's messages, in-service videos, holiday events, and other various services. 

I Agree
 - By signing this waiver, I,  
, acknowledge assumption of risk by sending my child to events during which photos and/or videos of them may be taken and/or streamed online. 


April 30, 2025


Designated Pick-up / Drop-off Individual's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
First Designated Pick-up / Drop-off Individual's Name

First Name*

Last Name*

Phone*
First Designated Pick-up / Drop-off Individual's Age Acknowledgment*
First Designated Pick-up / Drop-off Individual's Date of Birth*
I certify that I am 18 years of age or older
First Designated Pick-up / Drop-off Individual's Signature*
Second Designated Pick-up / Drop-off Individual's Name

First Name*

Last Name*

Phone*
Second Designated Pick-up / Drop-off Individual's Date of Birth*
Third Designated Pick-up / Drop-off Individual's Name

First Name*

Last Name*

Phone*
Third Designated Pick-up / Drop-off Individual's Date of Birth*
Fourth Designated Pick-up / Drop-off Individual's Name

First Name*

Last Name*

Phone*
Fourth Designated Pick-up / Drop-off Individual's Date of Birth*
Fifth Designated Pick-up / Drop-off Individual's Name

First Name*

Last Name*

Phone*
Fifth Designated Pick-up / Drop-off Individual's Date of Birth*
Sixth Designated Pick-up / Drop-off Individual's Name

First Name*

Last Name*

Phone*
Sixth Designated Pick-up / Drop-off Individual's Date of Birth*
Seventh Designated Pick-up / Drop-off Individual's Name

First Name*

Last Name*

Phone*
Seventh Designated Pick-up / Drop-off Individual's Date of Birth*
Eighth Designated Pick-up / Drop-off Individual's Name

First Name*

Last Name*

Phone*
Eighth Designated Pick-up / Drop-off Individual's Date of Birth*
Ninth Designated Pick-up / Drop-off Individual's Name

First Name*

Last Name*

Phone*
Ninth Designated Pick-up / Drop-off Individual's Date of Birth*
Tenth Designated Pick-up / Drop-off Individual's Name

First Name*

Last Name*

Phone*
Tenth Designated Pick-up / Drop-off Individual's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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