Media Consent form

Full Name*

Participant

Age*

Parent Full Name

For Participants under 18 year of age

Consent for photographs and/or video*

I grant permission to have Photos taken for the following categories.

1. Print promotional materials (e.g. Annual Report, newsletter, leaflets etc)

2.Social Media

3. Loftus website and Perth Redback website

4.Newspaper/media stories – print and online

5. Digital content (i.e. photos, film or voice recordings captured for web, social media, YouTube etc)

Select or enter value

Participant Acknowledgement*

I acknowledge Receipt of information package

Sign - Full Name

Date *

Send me a copy of my responses