RELEASE FORM FOR MEDIA RECORDING

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The undersigned hereby consents and agrees that First United Methodist Church of Mountain Home, AR (hereinafter referred to as FUMCMH), its employees, or agents have the right to use, show, publish, dissimilate, take photographs, videotape, or digital recordings of me on the church premises and/or at any church function, and to use these in any and all media, now or hereafter known, and exclusively for the purpose of promoting or advertising the FUMCMH programs, services, and activities. I further consent that my name and identity may be revealed therein or by descriptive text or commentary.

I hereby release to FUMCMH, its agents, and employees all rights to exhibit this work in print and electronic form publicly or privately for non-commercial use.  I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used by FUMCMH.

I understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmission or playback.

I also understand that FUMCMH is not responsible for any expense or liability incurred as a result of my participation in this recording, including medical expenses due to any sickness or injury incurred as a result of such activity at no fault of FUMCMH.

I represent that I am at least 18 years of age, am competent to execute this agreement, and have read and understand the foregoing statement.

Name: _________________________________________        Date: _____________________

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Address: _______________________________________        Phone No.:_________________

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Witness for the undersigned: _______________________

Signature: __________________________________

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07 AUG 21 - FUMC-WAIVER