Media Release

Media Release and Consent Form

The purpose of this release form is to gain informed consent to display images of a person on our website, or on printed items such as training and marketing materials.

This form provides for an individual or guardian to make a formal declaration of consent.

For further information please contact support@encouragingminds.com.au

Participant Details

First Name

Last Name

Please enter your age

Parent of Guardian

Some description about this section

First Name of Parent or Guardian

Last Name of Parent or Guardian

Media Release Declaration

I, , grant permission to Encouraging Minds (herein after known as the “Media”) to use my image (photographs/video) for use in Media publications including:

Videos
Email Blasts
Recruiting Brochures
Newsletters
Magazines
General Publications
Website and/or Affiliates

I hereby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image.

I am 20 years of age or older and I am competent to contract in my own name. I have read this release before signing below and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.

I am the parent or legal guardian of the below named child. I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.

Signature

Sign Here

Signature of Parent or Guardian

Sign Here

Date