Media Consent Form

Disclaimer

By filling out this form, I allow Ajax Public Library to use photos or videos taken of me and/or my children during visits or participation in Library activities. This media may be used for Ajax Public Library publicity, including online and in print. My name may be attributed to the media, while children will only have their first name(s), last initial, age, or grade attributed. All media collected becomes Ajax Public Library's property. I understand and voluntarily consent to this arrangement.

Name(s) of Subject(s)

Please input the name(s) of all people to be captured in the photo or video, for which the person completing the form has responsibility over.

Name of Guardian

Email Address

Phone Number

Virtual Signature

I agree.

I understand and agree to the terms of the Media Consent form, and have responsibility for the above named person(s).

Disclaimer

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