RHW Storytellers Participant Release Form

Thank you for agreeing to be part of a media production for the Robinson Huron Waawiindamaagewin initiative.  In order to participate in our media productions, all participants are asked to complete the questionnaire below.  This questionnaire must be completed before your involvement is considered to be confirmed by RHW.

If you prefer not to complete this form online, you can download this form here.  After completion please sign, scan and return via email to mediaproduction@waawiindamaagewin.com.  If you are unable to send the document back to us digitally we can make additional arrangements to collect the form.

Please check the box to indicate your approval ("Yes") or disapproval ("No") of the following statements:

1) I hereby authorize RHW to photograph, video record, and audio record the interview or other activity featuring myself for the purposes of the agreed upon media production.
2) I grant all rights of every kind in relation to use, editing, and distribution of my performance, appearance, name and/or voice to the RHW initiative and relinquish any claims of damages or royalties.
3) I understand that my image, voice, and personal biographical information may be shared through various social media and digital communications platforms, or viewed in public exhibition at the discretion of RHW.
4) I wish to review the portion of the final product that features myself before public viewing or distribution occurs.

All further efforts to communicate with me can be directed to:

I accept that if RHW makes repeated attempts to contact me through my indicated proffered method of contact, and I remain unresponsive for a period of five (5) business days that the release of the portion of the final product that features myself may proceed without my further input or involvement of any kind.

The completed form will be printed and you will be asked to sign off on your submission.  Miigwetch, we look forward to working with you!