Name and Image Consent and Release Form

Standard Consent Form for Adults and Children

Image Consent Form for Adults

I hereby give Saugeen Valley Conservation Authority (SVCA), its employees, agents, assigns and legal representatives the irrevocable right to use my name, photograph, image, audio recording, video recording and likeness (collectively, “My Image”) in all forms and manner, including but not limited to: publication on SVCA owned and non-SVCA-owned property, print media, digital media, the Internet, social media sites, media releases and broadcasts, without further notification to you.

• I understand that SVCA cannot control unauthorized use of My Image by persons not associated with SVCA once My Image has been published.
• I hereby forever waive any right to inspect or approve any publication of My Image by SVCA.
• I hereby forever release and waive any and all claims I may have or ever have against SVCA, its elected officials, employees, agents, assigns and legal representatives for the use of My Image.
• I have carefully reviewed and understand the above provisions and agree to be bound by them.
• I voluntarily and irrevocably give my consent and agree to this release and waiver.

Note: The information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, CHAPTER M.56, as amended, to obtain your consent for the use of your name, photograph, image, audio recording, video recording and likeness of the Child(ren).

Image Consent Form for Children

I, the parent and/or legal guardian of the Child(ren) named below, hereby give Saugeen Valley Conservation Authority of Formosa (“SVCA”), its employees, agents, assigns, and legal representatives the irrevocable right to use the Child(ren)'s name, photograph, image, audio recording, video recording and likeness (collectively, the “Child(ren)'s Image”) in all forms and manner, including but not limited to, publication on SVCA-owned and non-SVCA-owned property, print media, digital media, the Internet, social media sites, media releases and broadcasts, without further notification to you.

• I understand that SVCA cannot control unauthorized use of the Child(ren)'s Image by persons not associated with SVCA once the Child(ren)'s Image has been published.
• I hereby forever waive any right to inspect or approve any publication of the Child(ren)'s Image by SVCA.
• I hereby forever release and waive any and all claims I may have or ever have against SVCA, its elected officials, employees, agents, assigns and legal representatives for the use of the Child(ren)'s Image.
• I have carefully reviewed and understand the above provisions and agree to be bound by them.
• I voluntarily and irrevocably give my consent and agree to this release and waiver.

Note: The information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, CHAPTER M.56, as amended, to obtain your consent for the use of your name, photograph, image, audio recording, video recording and likeness of the Child(ren).