This permission slip allows Hope Lutheran Church to take and publish photographs and videos of individuals attending services and events. It gives consent for images to be used in the church newsletter, website, Facebook page, and Twitter account. By signing, individuals understand their images can be viewed worldwide on the internet but will only include first names for security, unless otherwise specified in the notes section.

1. Image Usage Permission Slip
I hereby give permission for my image or the image of a minor under my guardianship to be
taken at Hope Lutheran Church in De Pere (includes: photograph and video). I also give
permission for these images to be published in the "Anchor Line" newsletter or on the World
Wide Web at www.hopedepere.org (home page), www.facebook.com (Hope De Pere), and
www.twitter.com (HopeDePere), unless otherwise noted*.
By singing below I understand that the images will be located on the World Wide Web and can
be seen throughout the world by people with access through the Internet. For security reasons,
only first names will be used, unless otherwise noted*.
Minor's name Relationship to minor
Signature Date
* Note
04 January 2010, last revised