Media Opt-Out - Impact City Church

We at Impact City Church would like to share photography and/or video recorded at our various ministry activities, events and programs in church-produced materials, including, but not limited to brochures, newsletters and other printed materials, on the church website, and church social media accounts.

Accordingly, participation in church activities implies permission for publication of any media recorded, unless a “Media Opt-Out Form” is on file with the church.

I am the parent/legal guardian of (please print the names of those you wish to opt-out in the space below), and I DO NOT give permission for my child(ren)’s image to be used in any Impact City Church publication, website, or social media account.

Name of Person(s) to Opt Out:*
Your Name*
First Last
Your Email*
Phone*
Date of Submission*
Month
Day
Year