Consent and release agreement

I, space to insert name of parent or guardian (name of parent or guardian), am the parent or legal guardian of space to insert name of child (name of child), a minor child ("my child").

I hereby consent to the participation of my child in the following event:

space to insert description of event (describe event)

located at space to insert location of event (location of event)
on space to insert date of event (date of event)

I also hereby consent to the use of my child's name, picture or photograph to be used, reused, altered, adapted, modified, cropped, produced, reproduced by mechanical or electronic means, published, republished, displayed, broadcast, distributed to the public, communicated to the public by telecommunication or exhibited in public, preserved, conserved and archived by (name of school/setting) or by the Government of Canada, for any purpose, including but not limited to, in any publication, broadcast, posting on the Internet (Web), advertising or display.

I agree that I shall have no claim against (name of school/setting), the Government of Canada or against anyone accessing or using images or videography taken at the event and that neither I, nor my child will be compensated in any way for the use my child's name, picture or photograph.

I confirm that I have not given anyone the exclusive right to use my child's name, picture or photograph. I hereby release and hold harmless (name of school/setting) or the Government of Canada from all claims, demands or causes of action arising out of the use of my child's name, picture or photograph.

I declare that I have read and understood the foregoing release and authorization before signing below.

Print space to insert printed name Sign space to insert signed name

Signed at space to insert location (location), this the space to insert day of the month day of space to insert month, 2016.

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