MINOR PARTICIPANT RELEASE For the CBC Vancouver Junior J School workshop taking place on Saturday, January 23, 2016, I the undersigned, , the parent of , agrees that this child may be photographed, filmed and/or interviewed by CBC/Radio-Canada. I understand that the footage of this child, as well as the interviews, may be broadcast in whole or in part at the discretion of CBC/Radio-Canada. The consent described herein is given free of charge and without restrictions. On my own behalf and on behalf of the child named above, I release CBC/Radio-Canada, as well as its administrators, officers, directors, agents, employees and representatives, from all responsibility and waive any claim (including claims based on copyright, privacy and image/picture rights, on defamation, and on losses and inconveniences) arising directly or indirectly from his/her participation in the filming or any CBC/Radio-Canada–authorized broadcast (including on TV, radio, the Web, multimedia platforms), in whole or in part, of the footage and interviews described herein. By registering for the CBC Junior J School workshop, I agree that the child named above will attend the workshop for the entire duration.

__________________________________ (Signature of the parent) Student’s Name: ____________________________ School Name: ______________________________ Grade: ______________________________ Email Address: ___________________________ Home Address: ____________________________________________________ Telephone: __________________________________________________ Date: ______________________________

PLEASE RETURN THIS FORM TO: CBC British Columbia English Communications Email: [email protected] Fax: 604-662-6335