I ,the undersigned, do hereby grant or deny permission to Teamworks Dufferin/Zachary's Camp to use the image of my child/ward as marked by my selections below. Such use includes the display, distribution, publication, transmission , or other use of photographs, images, and/or video taken of my child/ward for use in materials that include, but may not be limited to, printed materials such as brochures, newsletters, videos, and digital images such as those on Teamwork's Website (teamworksdufferin.org)
I GRANT permission to use my child's/ward's image in the following way
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Name and Date *
Your answer
A copy of your responses will be emailed to the address you provided.