Submission for Online Gallery

Contact Information

First & Last Name:

Address:

City

Province

Postal Code

Email Address:

Phone Number

Images:

Maximum upload size: 209.72MB

Photo Release and Assignment

By submitting this form I hereby irrevocably consent to and authorize The City of Port Coquitlam, its agents or assigns, the irrevocable and unrestricted right to use and publish images of myself for editorial, trade, advertising, promotion or any other lawful purpose in any manner or medium, and to alter the same without restriction and without the payment of any compensation. *

Further, in favor of the City, I do hereby: (1) waive any right to notice or approval of any use of the mages; (2) release the City and its agents or assigns from all claims and liabilities relating to the images of myself or by virtue of alteration, processing or use in composite form;

I hereby represent that I am over 18 years of age and the right to contract in my own name, and also state that I have read this document prior to submitting this form and that I fully understand its contents.

Participants of a minority age

This is to certify that by the act of submission I/we as parent(s)/guardian(s) with legal responsibility for this photo subject, do consent and agree not only to his/her release, but also for myself/ourselves, and my/our heirs, assigns and next of kin to the Release and Assignment, as stated above, regarding my/our child’s involvement in the taking and use of the Images as stated above.