EarlyON | Waterloo Region Photo Release Form

EarlyON | Waterloo Region Photo Release Form
I understand that myself, whose name is listed below, may be photographed at any EarlyON program or location during normal program hours in Waterloo Region.

I understand that there will be no payment for my participation in this release.

I understand that if I wish to revoke my photo consent, it is my responsibility to contact earlyyearsinfo@ytr.ymca.ca in the event that I no longer wish to authorize the above uses.

I understand that if I later revoke my photo consent, pictures taken while my consent was on file may still be utilized by EarlyON | Waterloo Region.
My Name*

First NameLast Name
My Postal Code*

Street Address

Street Address Line 2

CityState / Province
By checking "yes" below, I grant permission for myself to be photographed for print or digital use, in promoting the services of EarlyON Waterloo Region.*

YesNo
Are you the parent or legal guardian of a child(ren) that you are bringing to an EarlyON Centre?*

YesNo

I understand that my child(ren), whose name(s) listed below, may be photographed at any EarlyON program or location during normal program hours in Waterloo Region.

I understand that there will be no payment for my child(ren)s participation in this release.

I understand that if I wish to revoke my child(ren)s photo consent, it is my responsibility to contact earlyyearsinfo@ckw.ymca.ca in the event that I no longer wish to authorize the above uses.

I understand that if I later revoke my child(ren)s photo consent, pictures taken while the consent was on file may still be utilized by EarlyON | Waterloo Region.
By checking "yes" below, I grant permission for my child(ren) to be photographed for print or digital use, in promoting the services of EarlyON Waterloo Region.*

YesNo
Number of Children*
Child's Name*

First NameLast Name
Child's Birthday*

MonthDayYear
Birth month and year required. If day unknown, please choose the 1st of the month.
Child's Name*

First NameLast Name
Child's Birthday*

MonthDayYear
Birth month and year required. If day unknown, please choose the 1st of the month.
Child's Name*

First NameLast Name
Child's Birthday*

MonthDayYear
Birth month and year required. If day unknown, please choose the 1st of the month.
Child's Name*

First NameLast Name
Child's Birthday*

MonthDayYear
Birth month and year required. If day unknown, please choose the 1st of the month.
Child's Name*

First NameLast Name
Child's Birthday*

MonthDayYear
Birth month and year required. If day unknown, please choose the 1st of the month.
Child's Name*

First NameLast Name
Child's Birthday*

MonthDayYear
Birth month and year required. If day unknown, please choose the 1st of the month.

Thank you for completing our EarlyON Waterloo Region Photo Release Form.

If you wish to remove your consent, please email earlyyearsinfo@ckw.ymca.ca

If you wish to update your photo consent by adding another child, please complete the form again with the information for the additional child.

Please press "DONE" to submit your information.
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