Youth Volunteer & Parent’s Publicity Permission Form

Dear Youth Volunteer and Parent/Guardian:

As part of our records, we ask that each of you read and complete the following form and return it to our office:

Youth Volunteer:
I, ______________________, consent to use of my name and photograph to be used for publicity and promotion purposes by Literacy Partners of Manitoba, and I waive all claims for compensation for such use or for damages.

Signature: _______________________ Date: ______________________

Parent/Guardian of Volunteer Under age l8
I, ___________________________, consent to the use my son/daughter’s name and photograph to be used for publicity and promotion purposes by Literacy Partners of Manitoba, and I waive all claims for compensation for such use, or for damages.

Signature: _______________________ Date: ______________________

Date received by LPM: _____________________________________________________

Please return this form to Literacy Partners of Manitoba
Thank You.