Authorization to image rights

please fill in the information below.
I AUTHORIZE the photo material captured by me to be shared with Mouvement Santé mentale Québec and of which I am the subject, be used without restriction of duration or territory for promotional purposes within the Step Out of The Frame project of the Make Choices To Open Doors campaign and any subsequent editions of youth creation projects by Mouvement Santé mentale Quebec and its partners.
I was informed that the shot could be modified and that it could be used in all types of current or future media. By the same token, I waive any form of remuneration as well as any recourse or prosecution of any kind against Mouvement Santé mentale Québec and its partners.
For all questions do not hesitate to communicate with us:

Note : you may send us a picture of the signed release form.