Media Release Form

I agree to permit the Gravenhurst Health Hub and Rotary Club of Gravenhurst and those authorized by them, to take photographs, video and/or sound recording of me.

I further agree that the Gravenhurst Health Hub may use photographs, video or audio in any medium (i.e print, web, TV, radio, social media) for (a) educational purposes; (b) fundraising i.e promotional, advertising or fundraising purposes; (c) media stories about the Gravenhurst Health Hub, in its discretion sees fit in perpetuity.

I agree that all uses/materials described herein are the property of the Rotary Club of Gravenhurst and I further acknowledge that I will not be entitled to any compensation for the uses/materials described herein.

I hereby release, discharge and hold harmless the Gravenhurst Health Hub, Rotary Club of Gravenhurst and its volunteers, affiliates, employees, representatives and agents from any and all claims, demands, or causes of action that I may have or may arise from the uses/materials described herein.

I represent and warrant that I have the full legal capacity to execute this release.  The rights I am granting do not conflict with any existing commitments or agreements.

I understand that my personal information, including images of me, is being collected pursuant to section 26 if the Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c.F.31.

I acknowledge that I have read this consent in its entirety, or it has been read (or translated) to me, and I have had the opportunity to ask questions about it and understand it.