First Name

Last Name

If you are associated with a DWF program, please indicate which one below: *

If you chose 'other', please explain

Name of Company/Organization/Group/School

Date of reconciliACTION

Tell us about your reconciliACTION (i.e.: event, initiative, song name, name of poem, etc)

Upload your reconciliACTION

I, hereby certify and give my permission for the Gord Downie & Chanie Wenjack Fund (DWF) and/or partners to use the uploaded recording, film, photograph, audio or/and video (known from here on in as “WORKS”) and to display, publish or distribute these Works for the purpose of publishing, posting on the DWF website, posting in Legacy Schools, Legacy Spaces, at public events, in educational materials, posting on social media sites and/or for broadcasting on television or radio as determined by DWF. I hereby waive any right to approve the use of these Works now or in the future, whether the use is known to me or unknown, and I waive any right to any royalties related to the use of these Works. I understand that the Works may appear in electronic form on the internet or in other publications outside of DWF’s control. I agree that I will not hold the DWF responsible for any harm that may arise from such unauthorized reproduction. Educators submitting on behalf of minors are expected to have parent/guardian waivers signed as per school rules and kept on file. By clicking this button you agree that all of this has been completed and the photos are free for DWF to use.