Story, Photograph, Video and Voice Recording Consent, Waiver, Indemnity and Release Form

The Alzheimer Society of Alberta and Northwest Territories (The Society) educates Canadians about Alzheimer’s disease and other forms of dementia by sharing photos, and sometimes stories, of people with dementia, their caregivers, and families.

By consenting, you are giving The Society permission to use your video, and/or photo on the website ( and sub-sites, on official Society social media platforms, and in publications or advertising/promotional materials. You are helping us to build awareness that will bring us one step closer to our vision of a world without Alzheimer’s disease and other dementias.

This content will be stored by Society and will remain accessible for The Society’s use for five years. After that time, the content will be removed from our image/video bank library. If you would no longer wish to have your content used before the established time period expires, please contact The Society in writing at [email protected].

The Society will make every effort to inform you each time your video or photo is being used.

Thank you for your support.