PHOTOGRAPH AND VIDEO RELEASE FORM
I,
being the mother/father/guardian of
give permission for the use of his/her likeness in a photograph/video captured by CDH Australia for display purposes in both Australian and international media and on the CDH Australia web site, from this date until advised otherwise.
I acknowledge that my child/(ren) will be identified by first name only where a name is required.
I hereby certify that I am the parent/guardian of
and do hereby give my consent without reservation to the foregoing on their behalf.
(Parent/Guardian’s Name)
(Parent/Guardian’s Signature & Date)
Please note: You may withdraw your permission at any time by emailing [email protected]; however, the use of your child’s image in retrospective media cannot be removed. Withdrawal of permission will only apply from the date the request is lodged.
