To Members, Friends, and Families that are Participants in Kiwanis Events and Activities.

Kiwanis International has asked each Club and Division to get your permission to use your photos and names to help promote our clubs in print, broadcast, and on the web. We are truly concerned about your security and want to keep all of you protected. In order to honor your requests we ask that you fill out this form to indicate your privacy concerns. Anytime you wish to change your status, all you have to do is fill in this form out again with your changes and print out a copy, and submit it to the club.  The Kiwanis Club of San Carlos Park-Estero website is hosted by GoDaddy.comthat hosts a number of websites, providing a secure server and even secure encrypted e-mail.  Our site is designed and published by our club webmaster. 

Please indicate below whether you grant us permission to use your picture / name should we be in a position to include your photograph in future publicity in print, on TV/Radio or on the Web.  Please indicate below your preference:

Complete Permission:

YES, I give the Kiwanis Club of San Carlos Park-Estero permission to use my name and photographs or my child's name and photograph in print, on TV/Radio, and on the Web, for public relations purposes, until I say otherwise.  ( I am over 18 year of age)

Limited Permissions

I give the Kiwanis Club of San Carlos Park-Estero permission to use only my first name and photographs in print, on TV/Radio, and on the Web, for public relations purposes, until I say otherwise.  ( I am over 18 year of age)

I give the Kiwanis Club of San Carlos Park-Estero permission to use only my name (no pictures please) in print, on TV/Radio, and on the Web, for public relations purposes, until I say otherwise. ( I am over 18 years of age)

I give the Kiwanis Club of San Carlos Par k-Estero permission to use my child's picture as long as you don't use the name in print, on TV/Radio, and on the Web, for public relations purposes, until I say otherwise.  (I am over 18 years of age)

I am:
Participant of a Kiwanis Activity or Event
I am:
Parent of a participant of a Kiwanis Activity or Event



   Name:                           Phone:

   Address:     

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I release the Kiwanis of San Carlos Park-Estero, Florida Kiwanis Division 19, and Kiwanis International from any liability whatsoever, as a result of volunteering and participating in Kiwanis activities.  

Kiwanis International, Kiwanis Divisions/Districts/Clubs assumes no responsibility for any sites linked to/from its Website, has no obligation to edit posted submissions, and reserves the right to edit, rewrite, and delete content that it deems inappropriate for any reason.