Required fields are marked with asterisks (*)

Region logo

Cultural Services Photo Video Consent Form

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

Personal information is collected under the authority of the Municipal Act, s. 11. The personal information provided is protected in accordance with the Municipal Freedom of Information and Protection of Privacy Act. Should you have any questions or concerns regarding the collection of personal information, please contact Information Management and Privacy at

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?