Northern Shuswap Tribal Council Northern Shuswap Treaty Society Photo/Video Release Form
Name
*
First Name
Last Name
Community
Please Select
Canim Lake Band
Stswecem'c Xget'tem First Nation
Williams Lake First Nation
Xatśūll First Nation
Other
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you
Youth - (up to the age of 18)
Adult
Elder
Authorization and Release
What is your preference regarding the use of your name?
I consent to the use of my complete name.
I consent to the use of my first name only.
I consent to the use of my nickname
I consent to the use of my photographs anonymously.
Please check the boxes regarding your preference.
*
I authorize NSTC/NSTS to take my photographs.
I authorize NSTC/NSTS to use my photos on Facebook, Twitter, Instagram, and other social media platforms.
I authorize NSTC/NSTS to edit, alter, copy, or distribute the photos for social media advertising and marketing.
I agree that the photos all intellectual property rights of the photos belong to NSTC/NSTS.
I agree that I will not receive any monetary compensation for usage of my photographs in social media platforms.
Please sign here if you're over the age of 18, if not please have your guardian/parent to sign for you
*
Date Signed
*
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: