ZACHARYS CAMP AND TEAMWORKS DUFFERIN MEDIA RELEASE FORM

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Zachary's Camp would like the opportunity to post pictures that were taken during 2023. No names or exact locations will be posted.

Untitled Title

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)

Description of Usage:

Name of Child/ward *

Name of Parent/Caregiver *

I DENY permission to use my Child's/ward's image at al

DENY

I GRANT permission to use my child's/ward's image in the following way

LIMITED USAGE: I want my Child's/Ward's image used within the Teamworks Dufferin setting only

UNRESTRICTED USAGE: Child's/Ward's image to be used in print, video or digital media

Usage on Facebook and Instagram

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