Change Conference Media Waiver – Youth for Christ Canada

Age of Majority*

I am over the age of majority in my province/country and am signing for myself
I am the parent/guardian of a minor in my care and signing on their behalf

*Age of Majority is 18 in AB, MB, ON, PE, QC, and SK and most countries, 19 in BC, NB, NL, NT, NS, NU, and YK

Participant Name*

First Last

Date of Birth*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email address for follow-up if required*

Parent/Guardian Name*

First Last

Relation to the participant

Parent/Guardian Work Phone*

Parent/Guardian Email*

Consent*

I agree

I agree to permit reasonable use of photos, videos, written materials or other pictures of in promoting Youth for Christ | Youth Unlimited and their activities and programs. I understand that these could appear in agency newsletters, brochures, websites or social media in (present and future material); or in local newspapers, on television, and might identify participants by first name.

I hereby give permission to Youth for Christ | Youth Unlimited to use photographs or any other media representation of at the discretion of the agency.

I release Youth for Christ | Youth Unlimited, its officers, directors, volunteers, and staff from any and all responsibility/liability that may arise as a result of the use of such photos/media.

BY giving permission to Youth for Christ | Youth Unlimited, we will NOT sell or distribute your photo to an outside agency or organization, and the material we create will be used for Youth for Christ | Youth Unlimited’s sole purpose.

I certify that as of today I am above the provincial age of majority.

Signature*