{"id":21677,"date":"2022-10-24T12:01:06","date_gmt":"2022-10-24T16:01:06","guid":{"rendered":"https:\/\/srvcanadavrs.ca\/?page_id=21677"},"modified":"2023-05-19T15:28:46","modified_gmt":"2023-05-19T19:28:46","slug":"personal-release-consent-form","status":"publish","type":"page","link":"https:\/\/srvcanadavrs.ca\/en\/personal-release-consent-form\/","title":{"rendered":"Personal Release Consent Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"21677\" class=\"elementor elementor-21677\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-a5d50df elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"a5d50df\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[{&quot;jet_parallax_layout_image&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;_id&quot;:&quot;3b5fd69&quot;,&quot;jet_parallax_layout_image_tablet&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_image_mobile&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_speed&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:50,&quot;sizes&quot;:[]},&quot;jet_parallax_layout_type&quot;:&quot;scroll&quot;,&quot;jet_parallax_layout_direction&quot;:&quot;1&quot;,&quot;jet_parallax_layout_fx_direction&quot;:null,&quot;jet_parallax_layout_z_index&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x&quot;:50,&quot;jet_parallax_layout_bg_x_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y&quot;:50,&quot;jet_parallax_layout_bg_y_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size&quot;:&quot;auto&quot;,&quot;jet_parallax_layout_bg_size_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_animation_prop&quot;:&quot;transform&quot;,&quot;jet_parallax_layout_on&quot;:[&quot;desktop&quot;,&quot;tablet&quot;]}]}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-9e02c42\" data-id=\"9e02c42\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-848fe57 uael-gf-check-yes uael-gf-ajax-yes uael-gf-style-box uael-gf-input-size-sm uael-gf-enable-classes-no uael-gf-button-left uael-gf-btn-size-sm elementor-widget elementor-widget-uael-gf-styler\" data-id=\"848fe57\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"uael-gf-styler.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"uael-gf-style uael-gf-check-style elementor-clickable\">\n\t\t<h3 class=\"uael-gf-form-title\">PERSONAL RELEASE FOR APPEARANCE IN A PHOTO, VIDEO AND\/OR MOVIE (\u201cRelease\u201d)<\/h3>\n\t\t\t<p class=\"uael-gf-form-desc\"><p style=\"margin-top: 20px;text-align: center\">Read the form in ASL: <a style=\"color: #5E1314\" href=\"https:\/\/www.youtube.com\/watch?v=mmpfNNbzdpc\" target=\"_blank\" rel=\"noopener\"> <u>https:\/\/www.youtube.com\/watch?v=mmpfNNbzdpc<\/u><\/a><\/p>\n<p>FOR GOOD AND VALUABLE CONSIDERATION and the payment or promise of payment to me of the sum of\nONE ($1.00) dollar, I hereby consent to my name, likeness, image, voice, and any other likeness\n(collectively, my \u201cLikeness\u201d) being recorded, photographed, filmed and taped by Canadian Administrator\nof VRS (CAV), Inc. (\u201cCAV\u201d) together with any and all information, biography, photos or materials of any\nnature provided by me (collectively, the \u201cContributions\u201d) and to include my Likeness and the\nContributions (in whole or in part, as is or as may be edited) in videos (and any related advertising or\npromotional materials) being produced by CAV (collectively, the \u201cProduction\u201d). Without limiting the\nforegoing, I hereby grant to CAV the following further rights:<br>\n<ul><li>I grant to CAV the irrevocable, fully paid up, royalty free, assignable, and sub-licensable rights and license, but not the obligation, to reproduce, publish, perform in public, exhibit, synchronize with other content, exploit, advertise and translate the Production throughout the universe, in perpetuity, in all languages, in and by any and all means and forms of media now known or in the future discovered and for any purpose.<\/li>\n<li>I agree that CAV\u2019s decisions to use or not to use the Production as set out herein is at its sole and absolute discretion and that I will have no right of approval, no claim to any compensation or benefit arising out of the use or exploitation of the Production.<\/li>\n<li>I release CAV, its officers, directors, employees, representatives, agents, licensees and any other entity involved in the development, production, or exploitation of the Production (collectively, the \u201cProduction Parties\u201d) from all claims of any kind that I or my heirs, executors, administrators, legal representatives, successors or assigns ever had, now have, or may in the future have, arising from, connected with, or in any way related to the use of the Production as set out herein.<\/li>\n<li>I agree that the Production will be the sole and exclusive property of CAV and I transfer, assign and convey to CAV, in perpetuity and throughout the universe, all right, title and interest of every kind whether now known or hereafter known (including without limitation copyright) in and to the Production. Further, I waive all moral rights (and all other rights of a like nature) in and to the Production in favour of the Production Parties and, without limiting the foregoing, I agree that I will not be entitled for any reason whatsoever to enjoin, restrain, or interfere with the distribution or exploitation of the Production.<\/li><\/ul>\nThis Release shall be governed by the laws of the province of Ontario and the federal laws of Canada.<\/p>\n\t\t<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_38' style='display:none'><div id='gf_38' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_38' id='gform_38'  action='\/en\/wp-json\/wp\/v2\/pages\/21677#gf_38' data-formid='38' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_38' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_38_21\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_38_21'>Company<\/label><div class='ginput_container'><input name='input_21' id='input_38_21' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_38_21'>This field is for validation purposes and should be left unchanged.<\/div><\/div><fieldset id=\"field_38_4\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_38_4'><div class='gchoice gchoice_38_4_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_4.1' type='checkbox'  value='I have read and understand this Release prior to signing and I am fully familiar with all terms herein. I warrant and represent that I have the full right, authority, and capacity to sign this Release, grant the rights granted herein and that no additional rights or consents are necessary to give full effect to the terms of this Release.'  id='choice_38_4_1' tabindex='1'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_38_4_1' id='label_38_4_1' class='gform-field-label gform-field-label--type-inline'>I have read and understand this Release prior to signing and I am fully familiar with all terms herein. I warrant and represent that I have the full right, authority, and capacity to sign this Release, grant the rights granted herein and that no additional rights or consents are necessary to give full effect to the terms of this Release.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_38_6\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I declare that I have reached the legal age of majority in my province or territory of residence.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_38_6'>\n\t\t\t<div class='gchoice gchoice_38_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Yes' checked='checked' id='choice_38_6_0' onchange='gformToggleRadioOther( this )'  tabindex='2'  \/>\n\t\t\t\t\t<label for='choice_38_6_0' id='label_38_6_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_38_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='No'  id='choice_38_6_1' onchange='gformToggleRadioOther( this )'  tabindex='3'  \/>\n\t\t\t\t\t<label for='choice_38_6_1' id='label_38_6_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_38_14\" class=\"gfield gfield--type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_14' id='input_38_14' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='30\/06\/2026' \/><\/div><\/div><fieldset id=\"field_38_7\" class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_38_7'>\n                            \n                            <span id='input_38_7_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_7.3' id='input_38_7_3' value='' tabindex='5'  aria-required='true'   placeholder='First Name'  \/>\n                                                    <label for='input_38_7_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_38_7_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_7.6' id='input_38_7_6' value='' tabindex='7'  aria-required='true'   placeholder='Last Name'  \/>\n                                                    <label for='input_38_7_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_38_8\" class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Witness Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_38_8'>\n                            \n                            <span id='input_38_8_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_8.3' id='input_38_8_3' value='' tabindex='10'  aria-required='true'   placeholder='Witness First Name'  \/>\n                                                    <label for='input_38_8_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_38_8_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_8.6' id='input_38_8_6' value='' tabindex='12'  aria-required='true'   placeholder='Witness Last Name'  \/>\n                                                    <label for='input_38_8_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_38_9\" class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_38_9' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_38_9_1_container' >\n                                        <input type='text' name='input_9.1' id='input_38_9_1' value='' tabindex='14'  placeholder='Street Address' aria-required='true'    \/>\n                                        <label for='input_38_9_1' id='input_38_9_1_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_38_9_2_container' >\n                                        <input type='text' name='input_9.2' id='input_38_9_2' value='' tabindex='15'  placeholder='Address Line 2'  aria-required='false'   \/>\n                                        <label for='input_38_9_2' id='input_38_9_2_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_38_9_3_container' >\n                                    <input type='text' name='input_9.3' id='input_38_9_3' value='' tabindex='16'  placeholder='City' aria-required='true'    \/>\n                                    <label for='input_38_9_3' id='input_38_9_3_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_38_9_4_container' >\n                                        <input type='text' name='input_9.4' id='input_38_9_4' value='' tabindex='18'    placeholder='Province' aria-required='true'    \/>\n                                        <label for='input_38_9_4' id='input_38_9_4_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Province<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_38_9_5_container' >\n                                    <input type='text' name='input_9.5' id='input_38_9_5' value='' tabindex='19'  placeholder='Postal Code' aria-required='true'    \/>\n                                    <label for='input_38_9_5' id='input_38_9_5_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_9.6' id='input_38_9_6' value='Canada' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_38_10\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_38_10'>Telephone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_10' id='input_38_10' type='tel' value='' class='large' tabindex='20' placeholder='Telephone' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_38_11\" class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_38_11'>Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_11' id='input_38_11' type='email' value='' class='large' tabindex='21'  placeholder='Email Address' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_38_12\" class=\"gfield gfield--type-signature gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_38_12'>Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><input type='hidden' value='' name='input_12' id='input_38_12_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_38_12_Container' class='gfield_signature_container ginput_container' style='height:180px; width:500px; ' ><canvas id='input_38_12' width='500' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#fafafa; cursor: url(https:\/\/srvcanadavrs.ca\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_38_12_toolbar' style='margin:5px 0;position:relative;height:20px;width:500px;max-width:100%;'><img id = 'input_38_12_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_38_12_data' name='input_38_12_data' value=''><\/div><\/div><div id=\"field_38_13\" class=\"gfield gfield--type-signature gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_38_13'>Witness Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><input type='hidden' value='' name='input_13' id='input_38_13_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_38_13_Container' class='gfield_signature_container ginput_container' style='height:180px; width:500px; ' ><canvas id='input_38_13' width='500' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#fafafa; cursor: url(https:\/\/srvcanadavrs.ca\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_38_13_toolbar' style='margin:5px 0;position:relative;height:20px;width:500px;max-width:100%;'><img id = 'input_38_13_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_38_13_data' name='input_38_13_data' value=''><\/div><\/div><div id=\"field_38_20\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p style=\"text-align: center;\"><u><b>*TO BE COMPLETED IF THE INDIVIDUAL IS UNDER THE AGE OF MAJORITY\nIN THEIR PROVINCE OR<br>TERRITORY OF RESIDENCE.<\/u><\/b><\/p><\/div><fieldset id=\"field_38_15\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent (Under Age of Majority)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_38_15'><div class='gchoice gchoice_38_15_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.1' type='checkbox'  value='I have read, understood and agreed to the foregoing Release. I represent and warrant that I am the parent or legal guardian of the individual named in the above Release, who is a minor, and that I am entitled and authorized to sign and agree to the terms of this Release on my own behalf and on behalf of the minor individual. I agree to indemnify the Production Parties against any loss or claim if the minor individual disavows the Release because the individual was a minor or for any other grounds whatsoever.'  id='choice_38_15_1' tabindex='22'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_38_15_1' id='label_38_15_1' class='gform-field-label gform-field-label--type-inline'>I have read, understood and agreed to the foregoing Release. I represent and warrant that I am the parent or legal guardian of the individual named in the above Release, who is a minor, and that I am entitled and authorized to sign and agree to the terms of this Release on my own behalf and on behalf of the minor individual. I agree to indemnify the Production Parties against any loss or claim if the minor individual disavows the Release because the individual was a minor or for any other grounds whatsoever.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_38_16\" class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_38_16'>\n                            \n                            <span id='input_38_16_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.3' id='input_38_16_3' value='' tabindex='24'  aria-required='true'   placeholder='First Name'  \/>\n                                                    <label for='input_38_16_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_38_16_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.6' id='input_38_16_6' value='' tabindex='26'  aria-required='true'   placeholder='Last Name'  \/>\n                                                    <label for='input_38_16_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_38_17\" class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Witness Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_38_17'>\n                            \n                            <span id='input_38_17_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_17.3' id='input_38_17_3' value='' tabindex='29'  aria-required='true'   placeholder='Witness First Name'  \/>\n                                                    <label for='input_38_17_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_38_17_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_17.6' id='input_38_17_6' value='' tabindex='31'  aria-required='true'   placeholder='Witness Last Name'  \/>\n                                                    <label for='input_38_17_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_38_18\" class=\"gfield gfield--type-signature gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_38_18'>Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><input type='hidden' value='' name='input_18' id='input_38_18_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_38_18_Container' class='gfield_signature_container ginput_container' style='height:180px; width:500px; ' ><canvas id='input_38_18' width='500' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#fafafa; cursor: url(https:\/\/srvcanadavrs.ca\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_38_18_toolbar' style='margin:5px 0;position:relative;height:20px;width:500px;max-width:100%;'><img id = 'input_38_18_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_38_18_data' name='input_38_18_data' value=''><\/div><\/div><div id=\"field_38_19\" class=\"gfield gfield--type-signature gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_38_19'>Witness Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><input type='hidden' value='' name='input_19' id='input_38_19_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_38_19_Container' class='gfield_signature_container ginput_container' style='height:180px; width:500px; ' ><canvas id='input_38_19' width='500' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#fafafa; cursor: url(https:\/\/srvcanadavrs.ca\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_38_19_toolbar' style='margin:5px 0;position:relative;height:20px;width:500px;max-width:100%;'><img id = 'input_38_19_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_38_19_data' name='input_38_19_data' value=''><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_38' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit' tabindex='33' \/> <input type='hidden' name='gform_ajax' value='form_id=38&amp;title=&amp;description=&amp;tabindex=1&amp;theme=gravity-theme&amp;styles=[]&amp;hash=e221447d881beebb64ee1401d9f14065' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_38' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_38' id='gform_theme_38' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_38' id='gform_style_settings_38' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_38' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='38' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='CAD' value='UYCdr+\/W9w\/vv0HBQnBNrRMtsX8ku07nbDQ5KgctPwvMohaZ5UC66IZD\/zhUKsiW\/Z7HqVr70Uc+bBXRdnpxHLmqW6POTdE16G4bQ1TIkc6YQPs=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_38' value='WyJ7XCI2XCI6W1wiNjU2ZTE5ZGRkYWM0MjE5YTQ5ZDJiNTJiNzExM2RjNjVcIixcImQzMDY0MmMzZGFmMzkyNmJiNDIyMTQ0MzNlZDI3NTM1XCJdfSIsIjQxNGQwN2RkNmY1NzcyOWU0ZDE0ZWY0OTMwYjdjMzE0Il0=' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_38' 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