JABC Media Consent Form

Please select one:

Yes, I authorize JA British Columbia (JABC) and JA Canada to allow photograph and/or video footage of me to be used in communications related to JA's programs and sponsors of these programs. I allow my name to be published in materials which may include the JABC websites, JABC print and web advertising and JABC social media channels.

No, I do not authorize JA British Columbia (JABC) and JA Canada to allow photographs and/or video footage of me to be used in communications related to JA's programs or sponsors of these programs.

I am aware that these photographs and videos may be used by the media for broadcast or in printed publications, included in displays and/or electronic media, and/or printed in publications to raise awareness of JA programs and activities. I understand that JA and JA sponsors will not use any images in a manner that may be deemed adverse or defamatory. I do not hold JA responsible for informal photos taken by other students participating in the program. This agreement may be cancelled at any time at the discretion of either party.

Full Name of Student/Participant

School/Organization

Name of Teacher (if available)

Are you 19 years of age or older?

YesNo

Full Name of Parent/Guardian

Parent/Guardian Authorization (I confirm I have read the media consent terms set above and agree to them)

YesNo

Date (yyyy-MM-dd)

Parent/Guardian Email Address

Parent/Guardian Phone

Contact Information