Consent release form

I hereby grant permission to the University of Waterloo and authorize the use by the University of Waterloo, its officers and employees, of my image, voice, and/or likeness.

I further grant to the University of Waterloo and its representatives the right to reproduce, use exhibit, display, broadcast, and distribute and create derivative works of these images and recordings in any media now known or later developed as well as my name, story, personal information including name (first name only for undergraduate students) for promoting, publicizing or explaining the University of Waterloo and its activities and for administration, educational, or research purposes. I acknowledge that the University of Waterloo owns all rights to the images and recordings.

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WAIVER, INDEMNITY, AND RELEASE

I hereby waive any right to inspect or approve the use of images or recordings or of any written copy. I further waive all moral rights. I also waive any right to royalties or other compensation raising from or related to the use of the images, recordings or materials.

I hereby release, defend, indemnify, and hold harmless the University of Waterloo, its Board of Governors, officers, employees, or agents from and against any claims, damages or liability arising from or related to the use of the images, recordings or materials, including but not limited to claims of defamation, invasion of privacy, or rights of publicity or copyright infringement, or any misuse, distortion, blurring, alteration, optical illusion or use in composite from that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution.

Protecting Your Privacy: In accordance with Section 39(2) of the Freedom of Information and Protection of Privacy Act (1990), personal information including images and recording in connection with this form is collected under the authority of the University of Waterloo Act (1972) and will be used for promoting, publicizing or explaining the University of Waterloo and its activities and for administrative, educational or research purposes. Personal information may be disclosed to outside service providers for processing and production. If you have any questions about the collection of personal information by the University of Waterloo as referenced in this form, please contact the Privacy Officer at University of Waterloo, 200 University Avenue West, Waterloo, N2L 3G1 or via email: fippa@uwaterloo.ca.