Release Form

AUTHORIZATION TO USE

World Vision Canada may use, reproduce, exhibit and communicate footage,
recordings or images of the Participant identified below taken during the CONNECT
Youth Conference on______________(date), in whole or in part or in combination with
or as a part of other matter, including limitation on the World Vision website and for use
by World Vision Canada and its authorized partners and licenses.

I hereby release, discharge and agree to save harmless World Vision Canada and its
licensees for any and all claims, demands or causes of action that I may now have or
may in the future have arising out of or relating to use of the above footage, recordings
or images of the Participant by World Vision Canada, its authorized partners and
licensees.

Any use, reproduction or communication of the footage, recordings or images shall be

for the exclusive use of World Vision Canada and its authorized licensees.

Name of Participant: (Please print) __________________________________

Signature: (Participant): __________________ Date: __________________

Signature of Guardian: ___________________ Date: __________________

(if participant is younger than 19 yrs.)

Relationship to Participant: ________________________________

Photocopy and complete this form for each CONNECT Youth Conference
participant.
Please bring completed forms with you to the CONNECT Youth Conference event.

www.worldvision.ca/connect