Pastors R&R produces audio and/or video (including photographic) materials for promotional purposes in an effort to gain acceptance, support and understanding of its mission, and to provide information. In all such audio/visual materials, Pastors R&R seeks to advance the dignity of all persons involved and reflect Christian values.

I hereby authorize and consent to being depicted in such audio/visual materials for publication, and release any and all rights I may have in such audio/visual materials, including any right to privacy. I hereby release Pastors R&R from any and all liability and damages whatsoever for the use of the audio/visual material in accordance with this Consent.

Such audio/visual material may be modified or retouched in any way that Pastors R&R deems advisable and I hereby consent to any such modification or retouching.

This consent can only be revoked by me in a writing delivered to Pastors R&R, and revocation will not be effective until actually received by Pastors R&R. Revocation will not affect the validity of this consent as to any publication prior to actual receipt of the revocation by Pastors R&R.

This Consent is not assignable without my further written consent.

1. Please complete the entire application as all fields are required.

Consent Form

1. Please agree to the above.
2. I
   Please Select One Do Do Not
3. consent to the use of my name in any such publication. Please list exceptions (if any) you have to the choice you checked above:
4. Exceptions
5. Signature *
6. Date
7. Signature *
8. Date