Image Consent Form

This form must be completed by athletes and participants and given to their coach or High Performance Director before participating in any CBSA sanctioned event. It must be completed before any images of athletes / participants are taken and used. If the athlete / participant is younger than the age of majority, it must be signed by their parent or guardian and provided to their coach / High performance Director.

Name of Participant (print): __________________________________________

Date: __________________________________

1. I hereby grant to [______________________ Insert Name of Participating Member organization(s)] and the Canadian Blind Sports Association (collectively the “Organizations”) on a worldwide basis, the permission to photograph and/or record the Participant’s image and/or voice on still or motion picture film and/or audio tape (collectively the “Images”), and to use the Images to promote the sport and/or the Organizations through traditional media such as newsletters, websites, television, film, radio, print and/or display form, and through social media such as Instagram, Facebook, YouTube, and Twitter. I understand that I waive any claim to remuneration for use of audio/visual materials used for these purposes. This consent will remain in effect in perpetuity.

2. I hereby fully release, discharge, and agree to save harmless the Organizations, for any and all claims, demands, actions, damages, losses or costs that might arise out of the collection, use or disclosure of the Images or taking, publication, distortion of the Images, negatives, and masters or any other likeness or representation of the Participant that may occur or be produced in the taking of said Images or in any subsequent processing thereof, including without limitation any claims for libel, passing off, misappropriate of personality or invasion of privacy.

3. I UNDERSTAND AND AGREE, that I have read and understood the terms and conditions of this document. On behalf of me, my heirs and assigns, I agree that I am signing this document voluntarily and to abide by such terms and conditions.

Signature of Participant: __________________________________________

OR, if the Participant is younger than the age of majority

Signature of Parent/Guardian: ___________________________________