Office of Evangelization atrd Catechesis
Roman Catholic  Diocese of  Albany


 Parish: (check one)                Clifton Park,     New York 

                                           St. Edward the Confessor St. Mary's of Crescent   

     
                    
PERMISSION FOR PHOTOGRAPHS/VIDEOTAPES/FILMS

I hereby authorize and give my consent for the taking of pictures (moving/still) of       and further give my permission for their  reproduction for:
  1.  Teaching puposes only
  2.  News Release
  3.  Publication 
  4.  Community  awareness  programs


______________                                                                  ___________________________________
       date                                                                                                                        signature
 
                                                                                                 ______________________________
                                                                                                                                relationship
 


This space may be used to state any restrictions you may have on the above.