PINER BAPTIST CHURCH

15044 Madison Pike, Morning View, KY 41063

Office #:  (859) 356-3222;  Fax #:  (859) 356-4181

 

 

Piner Baptist Church has put a web site on the Internet at www.pinerbaptist.org. Some occasions associated with the church may be photographed and put on our web site. We need your consent to use your photographs.

 

 

I, ________________________________________, give my permission for the Piner Baptist Church to use my name, photograph and likeness in promotional materials.

I understand that I will receive no compensation for this use.

 

Name:              _____________________________________________

 

Address:          _____________________________________________

 

City, ST:          _____________________________________________

 

Phone No.:      _____________________________________________

 

Email:              _____________________________________________

 

Date:               _____________________________________________

 

Signed:            _____________________________________________

Parents

Signature:        _____________________________________________