Media Opt Out Form - Vienna Presbyterian

Media Opt-Out

Would you rather that your child not be in any photos, videos, or used in any media for the church?

Please fill out the form below.

Media Opt Out*
Do not use photos, videos, or audio recordings of my child, or my child's name in any media.
Child's Full Name*
First Middle Last
Child's Birth Date*
Month
Day
Year
Parent's Full Name*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region
Phone*
Parent's Email*
Name of person submitting form.*
First Last
Parent(s) Signature*
Today's Date*
MM slash DD slash YYYY
CAPTCHA

OUR LOCATION

124 Park St, NE
Vienna, VA 22180
703.938.9050

FOLLOW US

© Copyright Vienna Presbyterian Church. All Rights Reserved.

Privacy Policy

WordPress Image Lightbox