Publication Consent Form

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The personal information on this form will only be used for the purpose of allowing the names, photographs, images, videotapes to be placed on the website, social media, bulletin board, newspapers and in publications and media; and allow for the interviewing of players and parents/guardians.

Please select 1 option

I consent to my daughter or myself being photographed, videotaped, or interviewed and our names and images to be used on the website, bulletin board, and in publications, newspapers and media coverage of the Russell and District Girls Hockey Association (RDGHA)

I DO NOT consent to my daughter or myself being photographed, videotaped, or interviewed and our names and images to be used on the website, bulletin board, and in publications, newspapers and media coverage of the Russell and District Girls Hockey Association (RDGHA)

Clear selection

Player Name

Team

U9 1

U9 2

U11 House

U11 Comp

U13 Houuse

U13 Tier 1

U15 House

U15 Tier 1

U18 House 1

U18 Tier 1

U18 Tier 2

Clear selection

Name of Parent/Guardian

Digital Acknowledgement

I knowledge my decision above

Submit

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