The Outdoor Activity Challenge 

The West Elgin Recreation Committee Challeneges you to get out and become more active.

There will be five (5) weeks of activites to complete. The activites will challenge your to get outside and become active.  

Let the community know how you have been active by dropping a picture in the drop box.

Notice of Collection of Personal Information

Personal information on this form is collected under the legal authority of the Municipal Act, as amended. This information is collected and maintained for the purpose of submitting a picture for the outdoor activity challenge with the Municipality of West Elgin.  Questions about this collection should be directed to the Clerk, at 22413 Hoskins Line, Rodney, ON 519-785-0560 or clerk@westelgin.net.  This information will be kept private and confidential unless otherwise required by law. 

Municipality of West Elgin 

Consent to Photograph/ Video 

Photo/Video Release Authorization 

I, the undersigned, give permission to the Municipality of West Elgin, and/or parties designated by the Municipality of West Elgin to photograph/video me and use such photograph(s)/video(s) in all forms of media, for any and all promotional purposes including advertising, display, audiovisual, exhibition or editorial use.

I further consent to the use of my name in connection with the photograph(s)/video(s) if needed by the Municipality of West Elgin and/or parties designated by the Municipality of West Elgin.

I understand and agree that I will not receive any payment for my time or expenses or any royalty for the publication of the photograph(s)/video(s) or the use of my name and I hereby release the Municipality of West Elgin and/or any parties designated by the Municipality of West Elgin from any such claims.

I certify that I have read and fully understand this consent and release, and that all questions pertaining to this consent have been answered to my satisfaction.

I agree that the information provided in the form is correct to the best of my knowledge and any miss information will prevent me from participating in future events.