Adult Photo Release Form
Fields marked with an asterix (*) are required.
To be filled out by person(s) shown in the image, NOT the photographer.
I,
, hereby authorize the qathet Regional District and City of Powell River and its agents permission to utilize my photographic image(s) in its public relations and communication materials (published and/or printed), which may include (but are not limited to): photo calendars, public internet pages, advertising collateral, electronic media, promotional materials and the like.
In giving my consent, I hereby release and hold harmless the qathet Regional District, City of Powell River and their agents, employees, officials, representatives and contractors from any and all responsibility or liability for damage of any kind suffered in any manner whatsoever related to the use of my photographic image(s) as contemplated herein.
I hereby relinquish any and all personal or proprietary rights I may have in connection with such use of my photographic image. I understand that I will receive no compensation should any photograph of myself be used or published.