Cultural Inclusion Camp – Media Release Form

CRE is a national Indigenous youth-led charity that collaborates with communities to provide programs, grants and opportunities. These initiatives are grounded in Indigenous ways of knowing and being and designed to strengthen and amplify the voices of Indigenous youth. Learn more about the work we do: https://canadianroots.ca/about/about-cre/

CRE was a primary funder of the Cultural Inclusion Camp hosted by Ravensong Consulting in late August 2022. Our Mi’kmaw staff Avery Velez and Sabrina Muise co-facilitated an age-appropriate session with the youth on Colonialism.

Filling out this form will allow CRE to use and share photos taken by Sarik Shaikh-Upadhye with our funders and on our online platforms @cdnroots! This helps ensure that we can continue to fund amazing projects like these into the future!

Youth name(Required)

First Last

Enter the age (under 18 years of age) of the youth(Required)

Authorize Question 1(Required)

I hereby authorize Canadian Roots Exchange (CRE) to record any images, audio and/video footage taken of the aforementioned youth, in whole or in part, individually or in conjunction with other images, audio, and/or video footage, to be reproduced, displayed, and/or distributed for educational, promotional advertising, and/or other lawful purposes.

Authorize Question 2(Required)

I release and waive rights to privacy and compensation, which I or the youth (under 18 years of age) indicated on this application may have in connection with such use of their name and likeness, including the rights to be written copy that may be created in connection with video production, editing and promotion.

Question 3(Required)

I am over 19 years-of-age and the parent or legal guardian of the youth (under 18 years of age) indicated on this application. I have read this waiver and am familiar with its content.

Parent / Guardian Name:(Required)

First Last

Signature of the Parent / Guardian(Required)

Date: 25/09/2023

To get in touch with CRE:
Phone: (416)-921-0079
Email: comms@canadianroots.ca

Social:
➢ Website: www.canadianroots.ca
➢ Facebook: www.fb.me/cdnroots
➢ Instagram: @CdnRoots
➢ Twitter: @CdnRoots

Main Office (Toronto):
➢ Canadian Roots Exchange
➢ 489 College Street, Suite 500
➢ Toronto, Ontario
➢ M6G 1A5
➢ info@canadianroots.ca

For communication in French, please send an email to comms@canadianroots.ca and a staff member will be in touch

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