FOIPPA - Consent for use of personal image & information
The personal information requested on this form is collected and protected under the authority of Peak Adventure Canada and the Freedom of Information and Protection of Privacy Act (FOIPPA), for the purpose of managing the use and authorization of personal information. Questions can be directed to info@peakadventure.ca.

We may use what you have agreed to consent on our website, social media accounts, or in projects and client work unless otherwise specified.

As we are collecting media for various clients, your consent to use your personal image and/or information means you agree to our selected clients owning the rights to the intellectual property captured in our media.
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Email *
Full Name *
Phone Number
Mailing Address
I authorize Peak Adventure to use the following text, video, photo, audio, and/or other media: *
Name, personal information, face & likeness, testimonial, artwork (non-attributed), and/or social media links for promotional, marketing, informational and/or educational purposes. We want to ensure your privacy is protected, so if there is any part of your personal information you wish NOT to share, please choose Other to list the specific media you agree to authorize (i.e. Other: I authorize everything except my last name).
Date signed *
MM
/
DD
/
YYYY
Electronic Signature Agreement
By submitting this form, you agree to sharing this information with Peak Adventure Canada and their use of your personal information and image based on the answers given. You agree that all of this information is true to the best of your knowledge.
A copy of your responses will be emailed to the address you provided.
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