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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

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Image Usage Permission Slip-full sheet

  • 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