273 E Queenwood Rd
Morton, Il 61550
(309)263-7899
Visit us: www.daysofgrace.org

Dear Parents,

We are working on upgrading our website and we need your help.  We have sent out this type of form in the past and have gotten some feedback that many parents would prefer a “one stop shop.”  We’re seeking to meet your needs.  So, please fill out the bottom portion.  These forms have no expiration.  If you would like to revoke your permission, simply give us written notification, and it will take effect immediately.  Please know that we will never publish your child’s name online.  Please notify us if you see anything that you think needs our attention.

After filling out the form below, please return to: Angie Kovarovic.

Please return by: ____________________    

Thank you in advance for your cooperation!

Team Media 

I, _____________________________ parent/guardian of:

        Please print your name

(Please list the names of all minor age children on lines below)

______________________________________________________

______________________________________________________

Grant my permission for Days of Grace Fellowship to use photos of the above listed child(ren) for use on its website www.daysofgrace.org.  I understand that no child will be identified and other safe guards will be employed to protect my child(ren) (i.e. not using a photo containing school names on a shirt).  This form is non-expiring.  If I choose to revoke my permission, I may do so at any time, simply by providing Team Media with written notification of my wishes.

____________________________                 __________________

                Signature                                           Date