Personal Release and Consent Form

I agree to be interviewed, photographed and/or videotaped by the Government of Canada and agree that the Government of Canada will own all rights in perpetuity throughout the world in any resulting story, photograph, audio recording and/or videotape for non-commercial use by the Government of Canada at any time in the present or future in various forms such as print, video and electronic media. I also agree that the Government of Canada will use my testimonials, the photos I took and the videos I filmed and shared with the Government. These photos and videos I have supplied may be used by the Government of Canada in perpetuity.

I consent to the use and disclosure of elements of my personal information, photographs, audio recording and/or videotapes.

I understand that my participation in the said project is voluntary and there will be no royalty fees paid to me by the Government of Canada for the rights to use this material.  My consent or refusal to provide consent will not impact any immigration applications I have submitted to the Government of Canada.

I understand that this personal information has been requested by the Government of Canada officials for possible use with the public by the Government of Canada, in any public forum and in any form or by any means, including statements in Parliament.

I agree with the above.