Your Community Health Image Consent Form (unlisted page)

Your Community Health image consent form

Your Community Health puts photos and videos of people like you in our newsletters and reports, website, social media and flyers. They help us share our work with the community. This forms gives us permission to use photos and/or videos of you in our work. Please contact us at marketing@yourch.org.au if you would like us to stop using your photo or video.

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Event or activity details

I understand that Your Community Health may use photos or video of me in their work:

I consent to Your Community Health using my image, artwork or image of my artwork in the following places:

Anywhere (unrestricted use)
Publications (brochures, posters, flyers, reports)
Website
Social media (Facebook, Instagram, etc.)

Date

Name

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Identifying features (i.e. red top, blue glasses):

If you are under 18 years of age, does your parent/guardian consent?:

Parent/Guardian Name

First

Last

Phone