Media Release Information

First of all, we would like to thank you for being open to sharing with Canopy!

Sharing your story is your decision. The organization will not offer additional resources or benefits to you for sharing your story (whether that be in words or images). Likewise, if you choose not to share your story, you will not lose access to the resources and benefits you currently have through our programs.

Why we are asking for your story

We want to share your story so that we can educate others, increase awareness of our cause and inspire our audiences to support our work by donating, volunteering and advocating for our cause.

How we will use your story

We appreciate you trusting us to tell your story. We may share your story, your image, or parts of your story in multiple formats, including websites, videos, email, and social media. We strive to represent your story and likeness authentically.

Who our audience includes

Other organizations that work with us

Donors (institutions, companies and groups of individual supporters) who support our work by providing funding and other resources.
General Public via media sources including newspapers, magazines, TV, social media accounts on Instagram, Facebook and LinkedIn and radio.

Your Rights

You have the right to access and update your story.
You have the right to change your mind at any time and revoke your consent. If you inform us, we will not use your story in future communications. Please understand that we may not be able to withdraw images and stories already published.

If you wish for your story to stop being used, or if you have any questions or comments about how your story is being used, please reach out to our Central Navigation team at 1-888-616-3456 ext. 200 or info@canopysupport.ca.

Download Media Release Information Handout Here

Name of Person Signing Consent

First Name

Last Name

Your Email

Are you completing this form for a specific Canopy event?

If not, please skip.

Name of Participants that the Media Release Applies To

Method

I give Canopy Support Services permission to collect media about me and the above named participants in the following formats: • Photography • Videography • Audio • Written

Yes, I agree.

Distribution

I authorize Canopy Support Services to use the methods described above and share in the following ways: • Website and Social Media: Including but not limited to Canopy’s website, Facebook, Instagram and LinkedIn. • Promotional Materials: Including but not limited to fundraising and program informational materials, newsletters, and annual reports (printed and digital). • Media Outlets: Including but not limited to use in newspapers, television, or radio. • Educational and Training Purpose: Including but not limited to presentations, workshops, and training sessions. This may include sharing with external organizations and agencies.

Yes, I agree.

Disclosure

I understand that the above formats may identify me by: o First Name o Face

Yes, I understand.

Restrictions

I agree to the above and have no restrictions I would like to identify at this time.

I agree to the above with the following restrictions listed below:

Please list restrictions.

Consent

I understand that if I have any questions about this form or how we will tell your story, please reach out to our Central Navigation team at 1-888-616-3456 ext.200 or info@canopysupport.ca. I understand that I may withdraw this authorization at any time in writing and this consent is not retroactive. I understand that Canopy may not be able to withdraw images and stories already published. I have read and understand this consent form. I have had all my questions answered to my satisfaction. I have signed this consent form freely and voluntarily.

Yes, I understand

Please Sign Your Name

By digitally typing your name, you agree that it serves as a legally binding electronic signature.

First Name

Last Name

Date

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