Required fields are marked with asterisks (*)

Model Release Form

First name

Last name

Phone number

Email address

Program or event

I authorize the Municipality of Clarington to use photographs or videos of (select all that apply)

My underage children or dependants

Publishing

I understand and agree that these photographs or videos may be published in any manner, including online, in print, or in video to promote Clarington programs, services, and events.

Retention

I understand that the Municipality of Clarington will retain these photographs and videos for an unlimited amount of time and that there will be no financial or other compensation provided to me for their use.

Consent statement

I confirm that I have read this release and fully understand its implications.

The personal information on this form is collected to obtain consent for the use of photographs and videos and is gathered under the authority of the Municipal Act. Please direct questions about this collection of information to the Municipal Clerk, 40 Temperance Street, Bowmanville, ON L1C 3A6 or 905-623-3379.