6401 San Pablo Ave. Oakland, CA 94608 | (510) 654-7600

Opt-Out Form

Saint Columba Media Release Opt-Out form

Submit this form only if you do not want media images or recordings of you, vulnerable adults under your charge or your minor children used in Saint Columba Catholic Church publications. If you wish to submit a signed release form in hard copy, please download: Media Opt Out Form.
The maximum number of form submissions has been reached. This form is currently not available.
- Objection to publication of media images by Saint Columba Catholic Church, Oakland, CA:
  
  I object to the release or use of any media images or recordings that will be produced, used, or distributed by Saint Columba Catholic Church for church purposes.
- Submitted By:
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date REQUIRED Please fill out this field. Please enter a date.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
- Names of Those Not to be Displayed
  Please provide first and last name of each person. One person per line
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