I hereby give consent to the Ecoforesty Institute Society (EIS) or representatives of EIS permission to use: a) any photographic images or video footage, taken of myself, in whole or in part, individually or in conjunction with other images and video footage taken; b) interviews and/or testimonials. This consent is given in perpetuity, and does not require prior approval by me. I understand the above will be used for media purposes including promotional presentations and marketing campaigns in various forms of media. This includes but is not limited to: • website and social media postings • newsletters • video footage • marketing and promotional campaigns • other uses related to Wildwood and the Ecoforestry Institute Society I realize and accept that I am participating on a voluntary basis and will not receive financial compensation from the photographer/videographer/interviewer, from the EIS or any firm publishing and/or distributing the finished product. *

Yes

No

Children under 18 years old must have a parent or legal guardian sign this waiver on their behalf. Are you signing this waiver as a parent or legal guardian? *

Yes

Parent/Guardians Name *

First Name

Last Name

Phone *

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Child's Teacher *

First Name

Last Name

Date of Wildwood Program if known

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DD

YYYY

Date *

MM

DD

YYYY