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Consent form

Participant Consent and Release Form 

I, the undersigned _____________________________________ (please print your name), grant the People’s Archive of Rural Ontario (PARO) permission to use all or part of the story that I share for the following educational and outreach purposes. (Please sign your initials next to each option that you agree to).  

 

I understand that by initialing and signing this form, I voluntarily and knowingly agree and consent to: 

 

_____ My final approved story and any associated images, videos, and/or audio being publicly visible in the PARO digital archive. [Note any comments or exceptions here] 

 

_____ My name will be publicly listed alongside my story.  

 

_____ My name will NOT be publicly listed alongside my story. 

 

_____ My story may be featured on the Rural Ontario Institute’s RURAL REBOUND website. [Note any exceptions here] 

 

_____ My story (in-full or in-part) may be used for research and learning, including in the classroom, peer-reviewed journal articles, academic conference presentations, etc., with due acknowledgement to the source.  

 

_____ My story and name may be used in a variety of ways by public users (e.g., journalists/the media), over which PARO will have no control.  

 

_____ I have the right to withdraw my story and any associated images, videos, and audio from the PARO archive (with 5 working days’ notice to the PARO team) at any time.  

  

 

By entering into this voluntary agreement, I as well as my representatives and successors assigns release and forever hold harmless The People’s Archive of Rural Ontario (PARO) from any and all claims, demands, damages, losses, obligations, rights, and causes of action, whether known or unknown, including but not limited to, all claims and causes of action that I now have or may ever have against the project relating in any way to this volunteer activity. 

 

 

 

Signature Date 

 

 

Mailing Address (Street, City, Province, Postal Code, Country)          

 

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