Tropicana Community Services Media Release

I consent and agree that Tropicana Community Services, its employees, and agents have the right to take photographs, and video/digital recordings of me as a participant or attendee of Tropicana Community Services events and programs, and to use these in any and all media, now or hereafter known, and exclusively for the purpose of advertising, promotion, and reports. I consent that my name and identity may be revealed therein or by descriptive text or commentary.

I do hereby release to Tropicana Community Services, its agents, and employees all rights to exhibit this work in print and electronic form publicly or privately and to market and sell copies. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used. I understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmission or playback.

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I am 18 years of age, and I have read and understand the foregoing statement, and I am competent to execute this agreement.*

First Name:*

Last Name:*

Date:*

Home Address:* (street number and name, unit/apartment number. city, province, postal code):

Email address:*

Phone/Cell:*

Requesting

Department:*

Program/Event:*