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Student Consent and Release Form
Name
*
Please enter your full name.
First Name
Last Name
Date
*
Please enter the date.
Phone
*
Please enter your phone number
Email
*
Please enter your school email address.
Institution
*
Please select the Institution you belong to.
Durham College
Ontario Tech University
Trent University Durham GTA
Course
*
Please select which course you are in:
Mental Health Challenges: Kimberlee Neault
Journalism - Feature Writing and Publishing: Teresa Goff
Community and Environment: Dimitri Stathopoulos
Site Planning and Analysis: Ali Taileb
Interactive Media Design/Contemporary Web Design: Linda Cheng
Photography: Brian Stephens
Recreation Administration, Finance, & Revenue Generation: Kelly Webdale
Capstone
Community Collaborations: Dani Cosby
Special Topics - Popular Music in Oshawa 64-79: Gary Genesko
Child & Youth Studies: Sara Ibaid
Consent
*
By signing this form, you are giving permission to the City of Oshawa, Ontario Tech University, Trent University, and Durham College to use any photos or videos of you and your City Idea Lab class project in promotional materials (such as websites, social media, or advertisements). You will not be paid for the use of your image or project, but you will be credited as the creator of the project and you will retain copyright of your project materials. Terms and Conditions: For valuable consideration, I hereby irrevocably grant to The Corporation of the City of Oshawa, the University of Ontario Institute of Technology, Trent University, and The Durham College of Applied Arts and Technology, and their respective employees, officers, directors, contractors, agents, licensees, assigns and legal representatives (collectively, hereinafter the “Licensees”) in perpetuity and throughout the world, a royalty-free right and license to (i) capture and record my name, image and likeness by any mechanical or electronic means, including without limitation, by way of a photograph, electronic image, video image, or “behind the scenes” footage (collectively, “My Image”) and (ii) to use, disclose, post, exhibit, license or otherwise exploit My Image, in all forms, using any medium, including without limitation, printed or online publications, digital media, websites, social media sites, media releases, online advertisements, and broadcasts, for the sole purpose of promoting and advertising the City Idea Lab, or the broader TeachingCity Oshawa initiative, and the courses, events, projects, contributions and results relating thereto. I agree that Licensees will exclusively own all rights in and to My Image, and that the Licensees shall be entitled to edit My Image in their sole discretion, as the Licensees may deem appropriate. I hereby irrevocably waive, in favour of the Licensees: (i) any moral rights that may be recognized now or in the future in connection with My Image in any jurisdiction throughout the world; and (ii) any rights that I may have at law or in equity, including but not limited to any privacy laws applicable and in effect from time to time, to control or restrain the public use of My Image. I further grant to the Licensees a perpetual, world-wide, royalty-free right and license to publish, display or reproduce, in whole or in part, any copyrightable materials or works created or developed by myself, solely or jointly with other participants, during my participation in the City Idea Lab course or project (“Project Materials”), in all forms, using any medium, for the purpose of promoting and advertising the City Idea Lab, its courses, events, projects, contributions and results. I retain all copyright in and to the Project Materials. I agree that the Licensees may freely assign or license this consent and release form and/or any right, licence or waiver granted herein, in whole or in part, to any third party. I understand that the Licensees cannot control the use or misuse of My Image and/or Project Materials by third parties once My Image and/or Project Materials has been published or made available in the public domain. I hereby irrevocably waive, in favour of the Licensees, any rights that I may have to inspect or approve the finished or unfinished publications, photographs or materials depicting My Image or Project Materials. I hereby forever release the Licensees from any and all claims that I may have, now or in the future, against the Licensees, arising out of or in connection with this consent and release form, and the licenses, rights and waivers granted in respect of My Image and Project Materials. This is the entire agreement between us pertaining to the subject matter hereof. The agreement shall be governed by the laws of the province of Ontario. Personal information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, CHAPTER M.56, (“MFIPPA”) as amended, and will be collected, protected, used, disclosed and retained by the Corporation of the City of Oshawa in compliance with MFIPPA or by any of its academic partners identified herein in compliance with the Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c F.31. This information will be used by Licensees to administer the City Idea Lab project and to obtain and verify consent relating to the collection, use and publication of participants’ names, images and project materials. Questions about use of this information should be directed to the Director, Innovation & Transformation, 50 Centre Street South, Oshawa, ON L1H 3Z7, 905-436-5633. I HAVE CAREFULLY REVIEWED THE TERMS OF THIS CONSENT AND RELEASE FORM AND UNDERSTAND THAT BY SELECTING 'YES' BELOW I AM WAIVING CERTAIN LEGAL RIGHTS. I VOLUNTARILY ACCEPT AND AGREE TO BE BOUND BY THE TERMS OF THIS AGREEMENT.*
Yes
Thank you!