Media Consent Form

 

Permission:

I hereby consent to the use of any photos or videos taken of my child by the (Centre Name) for use on the Centre’s website, internet, newsletters, local newspapers and advertising for the Centre and/or Centre events.

 

From time to time the Media (i.e. local newspaper) are invited to the (Centre Name) to cover an event or to write an article promoting the Centre. When this happens there is the possibility that your child may be photographed for the article.

 

As per the Privacy Act (Centre Name) will protect the privacy of all children and will not release any personal or identifying information.

 

This permission will be valid until such time that your child no longer attends the (Centre Name) or that a written withdrawal of the Media Consent is supplied.

 

YES, I give my permission to (Centre Name) to use photos and/or video of my child as outlined above.
NO, I do not give my permission to (Centre Name) to use photos and/or video of my child as outlined above.
Child's Full Name: *
Parent's Full Name: *
Address: *
Phone: *
Mobile: *