PERSONAL INFORMATION WAIVER
NOTE TO PHOTOGRAPHER OR VIDEO DIRECTOR:
Please be prepared to provide to Community Foundations of Canada (CFC) a copy of this form
for anyone whose image or personal information is included in your photo or video.
1. I acknowledge that I have provided my permission to Community Foundations of
Canada and it’s associated community foundations and the Government of Canada
to use, free of charge, my image with or without my name or other personal
information for purposes of his/her photo or video created for media purposes
including promotional presentations and marketing campaigns.
2. I consent to Community Foundations of Canada and it’s associated community
foundations and the Government of Canada using, reproducing, adapting, translating
and making my image with or without my name or other personal information publicly
available in any media (including the Internet and social media), free of charge,
throughout the world, for media purposes including promotional presentations and
marketing campaigns.
5. I waive rights to privacy and compensation, which I may have in connection with
such use of my name and likeness, including rights to be written copy that may be
created in connection with video production, editing and promotion therewith.
If the subject is a minor in his or her province or territory of residence, the parent or
legal guardian must sign this form on his or her behalf.
Subject’s name (print) Parent or legal guardian’s name (print)
Signature:
