R8, 2019-12-16

NOTE: Ecosource Mississauga does not accept paper waivers, please submit electronically.

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ECOSOURCE/PEYA PARTICIPANT PERMISSION & MEDIA RELEASE FORM

All participants must sign this form. If you are under 18, please complete this form with the help of a parent/guardian.

We protect and respect your privacy. Your personal information is used to communicate within our organization and will not be shared with any outside parties.

Informed Consent:

  1. By signing below, I consent to participate (or if the participant is under 18, give my child permission to participate) in Ecosource/PEYA related programs, activities and/or events at various locations for the 2019/2020 Academic School Year.
  2. I have read and understood the information in this form about participating in Ecosource/PEYA-related programs (or if the participant is under 18, give my child permission to participate). I hereby willingly consent to release Ecosource/PEYA and partner groups from all liabilities and waive all claims and demands arising from any personal injuries incurred while participating in Ecosource/PEYA related programs.
  3. I consent to photographs and/or videos taken of me during Ecosource/PEYA related programs (or if the participant is under 18, give consent for photographs/videos to be taken of my child). I understand that these photographs/videos may be used in the promotion of Ecosource/PEYA and/or Ecosource/PEYA's partners. They may be published or used for any application in newspapers, magazines, film and/or television commercials, social media, posters, slide presentations, or otherwise displayed to the public or used for educational, fundraising, informational, or training purposes - either in whole or in part by Ecosource/PEYA or a third party on behalf of Ecosource/PEYA.
  4. I understand that I will not receive any compensation for photographs and/or videos taken of myself or the participant while volunteering with Ecosource/PEYA.



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Signature

Sat Jan 4, 2025

By checking here, you acknowledge you have read and understand the above terms, and are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.