Permission for Release of Name and Image for Media Publication
Note: Please complete this form and click on submit at the bottom of this page. Then click on the next link to reach the signature page and sign your name.

Printable version available at: https://tinyurl.com/yb8ekymc

I hereby grant the display of a photograph of my son/daughter/ward and the release of her/his name for media publication in regards to the Ontario CEC Annual Provincial Special Education Conference; this may include the Ontario CEC website, Facebook page, printed conference materials and/or a press release.

The photo should be sent by email or text as a (jpeg file) attachment.

Email or text a photograph to:
Ana Lia Pauchulo, Awards Chair
analia.pauchulo@gmail.com

*** If 18+ and capable of giving consent, award recipient may sign for self.
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