Model Release Form

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CONSENT for Disclosure of Personal Information
(Photographs, Videotapes, and Audiotapes)
Full Name
Email Address
I authorize
(who made this video?)
and the Festival of Teaching to use the designated video/visual recording submitted to the
“Who is the greatest teacher of all time?” student video contest
recorded on
(date the video was recorded)
for the period of November 2011 to March 2013.
Signed this __________ day of _____________________, 20_______, at EDMONTON,
(signature of video participant)
(signature of contestant)
Protection of Privacy – The personal information requested on this form is collected under the authority of
Section 33 (c) of the Alberta Freedom of Information and Protection of Privacy Act and will be protected under
part 2 of that Act. It will be used for the purpose of managing the consent for disclosure of personal information
process. Direct any questions about this collection to: Karen Unger, Festival of Teaching Event Coordinator at


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