KCOG CONGREGATIONAL PHONE DIRECTORY RELEASE FORM

I / We ___________________________________________, undertake and agree to grant Kinnaird Church of God Ministry Staff/Volunteers the irrevocable right and unrestricted permission to publish, for the sole purpose of congregational communication, my/our personal contact information in the KCOG Phone Directory. By signing this form, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any persons or organization utilizing this material for the purposes listed above. *

If you are submitting for a family, please include the names of your children, in order from oldest to youngest, AFTER the parent(s)’ names. E.g. John & Susan Smith; John Jr., Billy-Bob, Nancy

Address*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Mobile Phone

Landline

Signature 1 (do your best!)*

Signature 2 (optional)

Today's Date*

KCOG CONGREGATIONAL PHONE DIRECTORY RELEASE FORM

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