Photo And Video Consent Form - City Of Edmonton printable pdf download

PHOTOGRAPHY & VIDEO CONSENT FORM

We are seeking your permission for your image to be taken and used as a visual that may be incorporated

into publications, advertisements, audio-visual presentations and/or Web pages, produced for the purpose

of public information and promotion of City of Edmonton programs and services.

❑ Yes, I give the City of Edmonton permission to take and use my photograph and/or video image for

inclusion in public information and promotional materials produced by the City of Edmonton.

_______________________________________

________________________

__________________

Name

Signature

Date

(Please print.)

(If under 18 years of age, parent or

guardian signature required.)

Video footage and photographs are deemed a record of information under the Freedom of Information and Protection

of Privacy Act (FOIP). This information/photograph/video is being collected under the authority of section 33(c) of the

Freedom of Information and Protection of Privacy Act, and will be used for the purpose described above with your

consent. Your personal information is protected from unauthorized access, use and disclosure through the privacy

provisions of FOIP. If you have any questions about the collection, contact: City of Edmonton Communications

Officer at 780-496-8266, or 3

floor, City Hall, 1 Sir Winston Churchill Square, Edmonton, Alberta..