Media Permissions | Bronte Seventh-day Adventist Church in Oakville, Ontario

Last Name*
This is the last name of the family for which you are filling in the form. It is also the last name that you'd like to have in the Church's directory.
Your First Name*
Your Date of Birth
Your Email Address
Children's Email Addresses (Optional)
Please enter the email addresses of any of the children or dependents in your household to whom you'd like email correspondence from the church sent.
PERMISSION TO EMAIL*
- Yes!
- No thanks.
May we have your explicit permission to send emails relating to events and happenings at our church to the email addresses that have you entered on this form? You may withdraw permission for any or all addresses at any time by sending an email to: communications@brontesda.com
Home Phone
Your Mobile Phone
PERMISSION TO TEXT*
- Yes!
- No Thanks
In 2017 we hope to start a new communication initiative that involves the use of text messages. Texting is an excellent way for us to communicate with each other and offers us the ability to automate sending out things like event reminders or last-minute announcements to the members of our church. We hope that you will participate. You may withdraw permission at any time. Incoming text messages may carry a very small cost based on your mobile phone provider.
Address
Please enter the address that you'd like to have listed in the Church directory as your home address. Ex: 5090 Johnson Road, Burlington, L9T 6L5

Are you married?*
- Yes
- No
Anniversary Date
Date Format: MM slash DD slash YYYY
Spouse's First Name
Leave blank if unmarried.
Spouse's Last Name (if Different)
Birthday
Tick if person is NOT a member of Bronte Seventh-day Adventist Church
- Not a member
Spouse's Mobile Phone Number
Spouse's Email Address

CHILDREN - DIFFERENT LAST NAME
I have one or more children who go by a different last name
- Yes
- No, we all share the same last name
Child #1 - First Name
Child #1 - Last Name
Birthday
Child #1 - Mobile Phone Number
Please don't sign up for text messaging
- No text messages please
Tick if person is NOT a member of Bronte Seventh-day Adventist Church
- Not a member
Child #2 - First Name
Child #2 - Last Name
Birthday
Child #2 - Mobile Phone Number
Please don't sign up for text messaging
- No text messages please
Tick if person is NOT a member of Bronte Seventh-day Adventist Church
- Not a member
Child #3 - First Name
Child #3 - Last Name
Birthday
Child #3 - Mobile Phone Number
Please don't sign up for text messaging
- No text messages please
Tick if person is NOT a member of Bronte Seventh-day Adventist Church
- Not a member

OTHER FAMILY MEMBERS
Are there other family members living at your address that you'd like to have included in the Church Directory?*
- Yes
- No thanks!
Other Family Member #1 - First Name
Other Family Member #1 - Last Name
Birthday
Tick if person is NOT a member of Bronte Seventh-day Adventist Church
- Not a member
Other Family Member #2 - First Name
Other Family Member #2 - Last Name
Birthday
Tick if person is NOT a member of Bronte Seventh-day Adventist Church
- Not a member
Other Family Member #3 - First Name
Other Family Member #3 - Last Name
Birthday
Tick if person is NOT a member of Bronte Seventh-day Adventist Church
- Not a member
Notes
Use this area to add notes about this entry

PERMISSION TO USE IMAGES
We hope that you will grant us permission to use photographic or video imagery taken of you and your family members in media like our website, social media and digital or print advertising. We will never use an image in a way that is inappropriate or not in line with the values of our church. You may withdraw permission at any time. You may also view the full policy on image usage on our church's website. www.brontesda.com
PERMISSION TO USE IMAGES*
- Yes, you may use images of me, my spouse and any children under the age of 18 added under my household
- You may only use images of me
- No, you may not use images that feature me, my spouse or children added under my household that are less than 18 years old
Comments
This field is for validation purposes and should be left unchanged.

CHILDREN - SAME LAST NAME