Spinal Cord Injury Ontario

Media Release Form

    Spinal Cord Injury & Cortree Release Form

    I hereby authorize Spinal Cord Injury Ontario/Cortree (SCIO/Cortree), its employees, authorized partners, third-party distributors, and legal representatives, the permission to use to reproduce, use, exhibit, display, broadcast, distribute and share any written/print works, photographs, video recordings, audio recordings, biographical information, and/or accompanying content that I provide, including the use of my name (collectively, “my image”), for use in all forms and manner, including but not limited to, publication on SCIO/Cortree and non-SCIO/Cortree properties, print media, digital media, online, social media sites, media releases and TV/digital broadcasts, without further notification.

    I hereby waive any right to inspect or approve any publication of my image by SCIO/Cortree. I have carefully reviewed and understand the above provisions and agree to be bound by them. I voluntarily and irrevocably give my consent and agree to this release and waiver.

    I accept and agree to the above terms:

    Please check YES to confirm consent if you are unable to use signature panel below:

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