Simon Fraser University

Consent and release form

(Photos, Videos, Recordings)

The Our Voices: Youth Building A Connected City conference will be documented with photographs and may be video-recorded. Any photographs will be stored by SFU and may be included on the SFU and SFU Public Square websites, and/or in other SFU and SFU Public Square materials. I (name)________________________________ hereby grant to Simon Fraser University (SFU) the right to take photographs, video recordings and sound recordings of me and/or my minor child or minor child under my guardianship, named below, at the Our Voices: Youth Building A Connected City conference, September 19th, 2012 at the Roundhouse Community Arts and Recreation Centre. Full name of minor child: __________________________________________ I further grant to SFU the absolute and irrevocable right and unrestricted permission to use, reuse, publish, and republish in any format, location or medium at any time such photographs, video recordings and sound recordings (the Material). I understand and agree that this permission applies to the Material in whole or in part, in any and all media now or hereafter known, for purposes of illustration, promotion, art, exhibition, editorial, advertising, broadcast, trade, or any other purpose whatsoever. I further grant to SFU the right to edit the Material before or after use, without restriction. I understand and agree that the Material and all worldwide copyrights therein shall be the sole and exclusive property of SFU, free of all claims by the undersigned or any other party. I understand and agree that SFU may identify me and/or the minor child named above in any use or reuse of the Material in which I and/or the minor child appear or am recorded. I hereby release and discharge SFU and its employees and agents from any and all claims and demands arising out of or in connection with the use or reuse of the Material, including without limitation any and all claims for libel or violation of any right of publicity or privacy. I understand that the Material is collected under the general authority of the University Act (R.S.B.C. 1996, c.468) and if I have any questions about the collection, use and disclosure of the Material I am to contact [Position Title, Business Address, Business Phone Number]. I am of full legal age and have the right to contract in my own name. I have read the foregoing and fully understand the contents thereof. This release shall be binding upon me and my heirs, legal representatives, and assigns.

Signed at _______________________________ on (date)________________________________ by (signature): ____________________________________________________________________