Photography/Video Consent and Waiver

PLEASE READ CAREFULLY

Event Description:______________________________________________________________________

Location:_______________________________________________Date:__________________________

Consent to Use My Image

I, ______________________________, consent to, and authorize the University of Manitoba, including
authorized representatives, successors, and assigns (collectively, the “University”), to:

☐photograph
■
☐video
■ record
☐audio
■ record

me or otherwise use my image, including my name, voice or both in the photographs and video recordings
(“my image”). I hereby grant the University the right to reproduce, use, exhibit, post, display, broadcast
and/ or distribute my image on/ in the following:

☐University-affiliated
■ social media accounts, including a University-affiliated YouTube channel;
☐University-affiliated
■ internet/intranet, including UM News;
☐University
■ of Manitoba learning management systems;
☐University
■ of Manitoba marketing and promotional materials;

☐Other:____________________________________________________________________________

for the purpose of promoting, publicizing or explaining the University and its activities and/or for
administrative, educational or research purposes. Photographs, video images and voice recordings are
the property of the University of Manitoba.

Waiver/Release
I waive all copyright interest including moral rights (except in the case of intellectual property licenced to
the University, as set out below), and any rights to claim royalties, or any other form of compensation or
interest arising from the University’s use of my image.
I forever release, discharge, indemnify and defend the University from and against any and all claims and
demands arising out of, or in connection with, the use of my image or recording, including but not limited
to, any claims for infringement of privacy, defamation, appropriation of personality, or copyright
infringement.

Intellectual Property (Where applicable)

Where an audio or video recording of the undersigned features a lecture, lesson, presentation,
demonstration or performance, I hereby grant the University of Manitoba a non-exclusive, world-wide,
royalty-free licence to use, copy, store, archive, communicate, telecommunicate, broadcast, reproduce,
sublicense, publicly present, modify, adapt, and distribute the recording of the lecture, lesson,
presentation, demonstration or performance in all media and formats now or hereafter known.
I warrant that the lecture, lesson, presentation, demonstration or performance does not infringe any
third-party rights, including but not limited to copyright, trademark or privacy.

NOTE : Where the undersigned is a member of the University of Manitoba Faculty Association (UMFA),
the undersigned acknowledges that they have been advised of their right to consult with UMFA prior to
executing this Consent and Waiver, and have exercised their own discretion in choosing to voluntarily sign
this document.

Declaration: I have read this Consent and Waiver and understand its contents are legally binding.

☐I
■ am more than 18 years of age.

Name (print):________________________________________________________________________

Signature:________________________________________________Date:______________________

☐I am under 18 years of age.

If the participant of the Event has not reached the age of majority, Parent or Guardian hereby gives their
irrevocable permissions to the University to use the images and recordings as outlined above. Parent or
Guardian must sign below and Print subject’s name above.

Participant’s name (print):_______________________________________________________________

Parent or Guardian Name (print):_________________________________________________________

Signature:_________________________________________________Date:______________________

Withdrawal of Consent
Consent can be withdrawn at any time, when practicable. Withdrawal of consent is not retroactive,
therefore the University is authorized to use your image as indicated above during the time in which
consent has been provided. In the case of publication, the removal of your personal information or
intellectual property may not be achievable if consent is withdrawn after publication has taken place.

Notice Regarding Collection, Use, and Disclosure of Personal Information by the University
Your personal information is being collected under the authority of The University of Manitoba Act. The
information you provide will be used by the University for the purpose of obtaining your consent and
release for the use of your image as indicated above. Your personal information will not be used or
disclosed for other purposes, unless permitted by The Freedom of Information and Protection of Privacy
Act (FIPPA). If you have any questions about the collection of your personal information, contact the
Access & Privacy Office (tel. 204-474-9462), 233 Elizabeth Dafoe Library, University of Manitoba,
Winnipeg, MB, R3T 2N2.

Issued August 19, 2019; Office of Fair Practices and Legal Affairs, Access and Privacy Office