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CiiAT - The Canadian International Institute of Art Therapy
The Proulx Global Education & Community Foundation
143 Joseph Street, Victoria BC, Canada, V8S 3H6
Phone: 1-866-452-4428
Email: [email protected] — [email protected]
Web: ciiat.org — proulxfoundation.org

Photo, Video, and Artwork Release Form

I, hereby grant permission to the Canadian International Institute of Art Therapy (CiiAT) and The Proulx Global Education & Community Foundation (PF) to:

Photograph or otherwise reproduce images of the artwork I create during therapeutic and/or training sessions.
Use images of my artwork for the purposes of educational case studies, supervision sessions, and other learning opportunities while ensuring my identity remains anonymous.
Discuss elements of my clinical history and progress in relation to my artwork for educational purposes, with my personal identity protected at all times.

I understand and agree to the following:

I retain the right to withdraw my consent for the use of my artwork or images at any time up to one (1) year after the final session I participate in.
I acknowledge that any artwork or creative work already published at the time of withdrawal may not be recalled or removed from publication.

I hereby release and discharge CiiAT, PF, their representatives, and any associated persons from all actions, claims, or demands that I or my heirs, executors, administrators, or assigns may have arising from the permissions granted under this agreement.

By signing below, I confirm that I have read and understood this release form and consent to the terms outlined above.

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2024-12-06 9:53 am PST

Photo, Video, and Artwork Release Form Uploaded by Behan Webster - [email protected] IP 216.232.132.131

2024-12-06 10:00 am PST