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Photo Release Form

Child/Participant First Name

Child/Participant Last Name

Parent Email

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I declare that the info I’ve provided is accurate & complete

I authorize Distinctly His Ministries and/or other parties involved with the Distinct Mentoring program to produce, reproduce, broadcast and otherwise use the photographs, films, videotapes, recordings, digital images, and other depictions, likeness or images of my child(ren)/participant, in any media form, worldwide, in connection with my child(ren)/participant attendance at or participation in the Distinct Mentoring program, or any other endeavor, without permission, notification, or compensation, for unlimited duration.

Parent Signature

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PO Box 764493

Dallas, TX 75376-4493

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