Region of Waterloo Form

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Required fields are marked with asterisks (*)

Photo and video consent form

This form gives the Region of Waterloo, and its agencies, permission to use photos and/or videos of you.

Personal information collected on this form will be used for the following purposes. It could be used for educational, promotional or other purposes the Region deems appropriate, without compensation to you. The Region holds full ownership of all photographic and video images.

First name:

Last name:

Email Address:

Date of event

What is the name of the event or program this photo is for?

To help us match your waiver to the photo, please describe the people in the photo and the activity when possible.

I allow the Region of Waterloo to use photographs and/or video of me for use in official Region of Waterloo material, including but not limited to:

publications
websites
promotional material
social media

I acknowledge that the personal information referred to above was provided freely and voluntarily. I have read this form and I understand its contents. I waive the right to any fee or compensation for the taking of my photo and/or video or the use or reproduction of it in any medium.

Are you 18 years of age or older?

Yes