Permission form
For students under the age oF 18
use oF image and recording
On behalf of my minor child:
I hereby grant Poetry In Voice/Les voix de la
poésie (PIV/LVP) permission for the use of my
child’s name, as well as his/her image or like-
ness from PIV/LVP’s photography, sound, and
video recording (“Materials”) of events associat-
ed with the Poetry In Voice/Les voix de la poésie
Recitation Contest.
I agree PIV/LVP may use, or authorize its assignees
or designees to use, all or portions of the Materials
to raise awareness about the PIV/LVP Recitation
Contest or to educate Canadians about an art form
or a particular artist in any of the following ways:
➊
Print media. PIV/LVP may use portions of the
Materials, such as a transcript and photograph,
in print materials.
➋
Audio CDs. PIV/LVP may include the Materi-
als in an audio CD that is created by PIV/LVP, a
PIV/LVP contractor, or a PIV/LVP partner.
➌
The Internet. PIV/LVP may utilize the Materi-
als in video, audio, or text format on its website
(poetryinvoice.com), on websites of PIV/LVP
partners, or on Internet-based social media chan-
nels (such as Facebook, YouTube, Twitter) and
live-streaming webcast sites (such as UStream)
in streaming and/or downloadable format.
➍
Radio. PIV/LVP may use the Materials on
radio, such as broadcast on commercial, public,
and Internet radio stations, and satellite radio
channels.
➎
Television. PIV/LVP may utilize the Materials
in television segments or programs to be aired
on local, public, national, cable, satellite, and/or
digital TV.
➏
Video/DVD. PIV/LVP may utilize the Materials
in a VHS or DVD, such as for a public service an-
nouncement or educational video.
➐
Successor technologies. PIV/LVP may utilize
the Materials in subsequently developed tech-
nologies.
hold harmless
I recognize that this permission includes
worldwide rights. I release PIV/LVP, and its as-
signees or designees, from any and all claims
and demands arising out of or in connection
with the use of the Materials.
On behalf of my said minor child, in the event
that he/she advances to the Poetry In Voice Na-
tional Finals (“Event”), I undertake to release
and hold harmless PIV/LVP, and its directors,
officers, employees, assignees, and appointees
from any damages incurred while travelling to
and from and while attending the Event.
I certify that I am the parent or legal guardian
of the child and have the right to agree to the
above.
Signature of Parent or LegaL guardian
Print name
Print Student name
date
addreSS
City, ProvinCe, PoStaL Code
Phone
click to sign
signature
click to edit
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