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Photo and Video Release

I, , hereby

agree

disagree

to have my name, photo and location released to Cerebral Palsy Association of British Columbia for marketing purposes.

My information:

Phone:
Email:
City:
CPABC Member:
CPABC Programs/Events participation:

I am 18 years or older.

I am under 18 years and will have my parent / guardian sign this form.

Parent / Guardian Name:

By signing below, I certify all information is true and correct to the best of my knowledge.

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Timestamp

Audit

May 4, 2020 9:33 pm PDT

Photo and Video Release Uploaded by Denzil Muncherji - info@bccerebralpalsy.com IP 23.16.74.222