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Image/Live Streaming/Audio Authorization and Release

A Conservative Congregation
Affiliated with the United Synagogue of Conservative Judaism

3919 Moran Road, Tampa, Florida 33618
B'ruchim Habaim: Welcome to Congregation Kol Ami

Image/Live Streaming/Audio Authorization and Release

We are delighted that you are interested in Congregation Kol Ami. It is our hope that new members will feel welcomed, at home, and a part of our congregational family. If there is anything on this form that you have questions about or are not sure how to answer, just let us know and/or fill it out to the best you can. Thank you for taking the time to give us your information. 

Image/Live Streaming/Audio Authorization and Release

Please review, sign (if you agree to the terms below) The consent is an eSignature signed by an adult family member on behave of the whole family. 


On my behalf and on behalf of those family members and children listed below:


  1. I hereby grant Jewish Association of North Tampa (d/b/a Congregation Kol Ami) (“Kol Ami”) and its employees, agents and personnel who are acting on behalf of Kol Ami permission and authorization to create and/or obtain and use any photographs, films, audiotapes, video recordings, audio recordings and/or electronic images/recordings of those family members and children listed below for purposes relating to the mission and/or operations of Kol Ami, including without limitation, synagogue publicity and reporting in the monthly newsletter (electronic and/or hard copies), the synagogue web site, weekly newsletters (electronic and /or hard copies), the Shabbat Shalom booklet, public advertising (i.e. the Jewish Press) and any other in-house publications and/or means of advertising including displays, posters, flyers, signs, etc. and live streaming of services and/or other activities occurring in Kol Ami’s facilities, all without payment or other compensation to me or to any of those family members and children listed below.


  1. I understand that these materials will become the property of Kol Ami and will not be returned.


  1. I hereby irrevocably authorize Kol Ami to edit, alter, copy, exhibit, publish or distribute these images for purposes relating to the mission and/or operations of Kol Ami or for any other lawful purpose.


  1. I waive the right to inspect or approve the finished product, including written or electronic copy, wherein any likeness or voice of any of the family members or children listed below appears.
  1. I understand that, although Kol Ami will endeavor to use these various items in accordance with standards of good judgment, Kol Ami cannot warrant or guarantee that any further dissemination of any of these items will be subject to Kol Ami’s supervision or control.


  1. I hereby hold harmless and release and forever discharge Kol Ami from any and all claims, demands, and causes of action which I and/or any of those family members and children listed below, and/or any heirs, representatives, executors, or administrators of any of them or any other persons acting on behalf of any them have or may have by reason of this authorization.


I have read and fully understand the contents, meaning and impact of this Authorization and Release.

Sat, October 16 2021 10 Cheshvan 5782