MCGILL&INTERNATIONAL&EXPERIENCE&AWARDS&
CONSENT&FORM
!
I,#the#undersigned,#hereby#grant#to#McGill#University#the#right#to#use,#reproduce,#distribute,#and#broadcast#
my#image,#including#my#name#and#likeness,#my#student#work,#and#my#affiliation#with#the#University,#
(collectively#referred#to#as#“Works”).##This#right#is#irrevocable,#royalty-free,#worldwide,#non-exclusive#and#
transferrable.#
I#understand#that#I#will#have#no#right#to#review#or#approve#such#Works#prior#to#the#use,#reproduction,#
distribution#or#broadcasting#thereof.##Furthermore,#I#agree#that#McGill#University#shall#have#the#right#to#
edit,#modify#or#otherwise#alter#the#Works.#
I#hereby#hold#harmless,#release#and#discharge#McGill#University#and#its#employees,#agenda,#licensees,#
successors#and#assigns#from#any#and#all#claims,#demands#or#causes#of#action,#resulting#from#the#use#of#the#
rights#granted#herein.#
Specifically,#in#relation#to#the#McGill#International#Experience#Awards,#I#consent#to#the#following:#
Confidential+Report+to+Donors+
Media+(e.g.,+website,+social+media,+
publications)+
I#have#read#the#Consent#Form#and#fully#understand#its#contents.##I#consent#to#the#use#of#these#images#and#
works#as#described#above.#
---------------------------------------------------# -------------------------------------#
SIGNATURE#OF#SUBJECT/PARTICIPANT# DATE#
Additional+Contact+Information#
Name# ---------------------------------------------------#
McGill#ID# ---------------------------------------------------#
Faculty# ---------------------------------------------------#
MIEA#Activity ---------------------------------------------------#
(include#dates#
when#activity#took#place)
Email# ---------------------------------------------------#
