Child Photo/Video Release Online Form

Name of participant

Name of Parent/Guardian	Phone	Email

Name of Witness	Phone	Email

I/we hereby give permission to use my name and my images, captured during regular and special therapy dog activities through video, photo and digital camera to be used solely for the purposes of Ottawa Therapy Dogs promotional material and publications, and waive any rights of compensation or ownership thereto.

Date:

You can also forward your digital video or photos to editor@OttawaTherapyDogs.ca

Thank you from...

Ottawa Therapy Dogs
Suite 750
1500 Bank Street
Ottawa, ON K1H 1B8

Should you have any questions, call 613.261.6834 (OTDI) or email us at info@ottawatherapydogs.ca