Video & Photo Release — Lutheran Indian Ministries

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About You

Full Name *

Please use your full legal name as you'd like it to appear in any captions or credits.

Email Address *

We'll send you a copy of this signed release.

Phone Number

Optional — only used if we have a question about your release.

City / Village / Community *

Tribal Affiliation (if you'd like it included)

About the Recording

Date of Recording *

Event or Healing Group *

Brief Description

How May We Use Your Video?

Choose the option that best matches what you're comfortable with. You can change your mind anytime by emailing us.

Yes — Public Use LIM may share my video on the website, social media, donor materials, and other public communications. Internal Use Only LIM may use my video for staff training, board recruitment, and partner-church previews — but please do not publish it publicly. No — Please Do Not Use I'd prefer that LIM not use my video. Please delete the recording.

Acknowledgements

Please check each box to confirm you understand and agree:

I am 18 years of age or older, or I am the parent/legal guardian of the person being recorded. I am giving this permission freely and voluntarily, without pressure or expectation of payment. I grant Lutheran Indian Ministries the right to edit, copy, and use my image, voice, name, and recorded statements in accordance with the permission level I selected above. I understand I will not receive payment for the use of my video, and that I may withdraw this permission in writing at any time by emailing info@lutheranindianministries.org.

Signature

Type Your Full Name to Sign *

By typing your name above, you are providing your electronic signature, which has the same legal effect as a handwritten signature.

Today's Date *

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Thank you

Your release has been received. We're grateful you trusted us with your story.

A copy will be emailed to you. If you have any questions or change your mind, you can contact us anytime at info@lutheranindianministries.org.

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