Universal Photo Consent Release Form

Name*
First Last
Which Program are you participating in?*
Consent*
I agree to the privacy policy.
I hereby consent to the use of my image or voice in the form of a photo, audio, video or digital recording by any electronic means whatsoever, and hereby release all my rights whatsoever in the recorded medium which will be published and distributed by Can-Am Indian Friendship Centre (“CAIFC”) of the Ontario Federation of Indigenous Friendship Centres (the “OFIFC”) on their website or in an CAIFC/OFIFC publication. I understand that my image or voice will be reproduced and distributed in the form of a photo, audio, video and digital format on the OFIFC official website or in a publication.
Signature*
Date*
Date Format: MM slash DD slash YYYY
Witness Signature*
Includes consent for the following Child/Children in my care:
First Last
First Last
First Last
First Last
Please list any additional children's names here: